CERTIFICATE OF LIABILITY INSURANCE (6)
,:a.n 08 03 11: ~4a
William Fillmore
7275475909
10.2
',I""'"r'lRD
/-.,v,,,",,,, lit.
CEFtTIFICA TE OF LIABILITY INSURANC~~~~ $ D~~E~~~~o'!o)2
nlls CERTIFICATE IS ISSUED AS A MATTER OF INFORl\lATlON
ONLY AMD COlll~ERS NO RIGHTS UPON THE CERTIFIC A l'E
HOLDER. THIS CERTifiCATE Does NOT AMEND. eXTEND OR
ALTER THE COVERAGE AFFORDED BV THE POLICIES 6ELOW.
~~~
T:.:.... Connelly J:nsura:lce Group
030 c~estnQt Street
~'_-::, Box 2456
::earWllte~ FL 33757.2~S6
';.b,"'",e: 727-46l-604~ FIlX:727-442-7695
INSURERS AFFORDING COVeRAGE
Head Start ,~hild Developmene
& F~ily SecviceB
5Gge 68th A',enue, North #D
~inellas Pa~k FL 337al-~063
INS\iRERA )l..ce American 1.n.surane~
..-.. - .._- -
INSuKFR [). Aro.eri:Jl,,1re In:Jv.rance
.._.~ .--_. --..
INSUKl::RC Great l\xO.erican Ins. CO. of N'l
INSURel'( o.
INSURl::R t
,', ....l,..'
COVERAGES
TI Ie rOLlC'~$ OF INSURANCC LISl E i) DCLOW HAVE DCCN I:;SUED TO THE INSURCD NAMED 1\ll0'J'l: FOfl nit POLICY PERIOD INDICA'ITD. NOTWITHSTANDINC
ANY RtOUIRC.MiONT, TCRM O~ CDNIlITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RIOSPECT TO WHICI-l THIS cE:f(TIFICATt MAY BE ISSUED 011
MA Y PeRTAIN, THC INSURANCE: ArF JKOEO DY THE 1'O~lCltS OESCIlIOCD HERtOIN IS SUBJECT TO ALL THr: TF.JlMS. EXCLUSIONS AND CONDITIONS O~ SUCH
PO'.I(;II:'!'\, AGCRECATI; LIMITS SHO'VIII MAV HAVE DCCH Rr:DUCtD BY PAIl) CLAIMS
:\,'~~
"_ -:-1-\
TVPS 01' INSURANCE
OSNCRAL UA",ILlTY,
X I COMMeRCIAL CFNtRAL LII ElILITY
, 1 C1.AIMS MAllF I X I )CCUR
POUCV "liMBER
A
G20400El69
01/01/03
01/01/04
LIMrt$
eACH OCCURRCNCE $ 1,.9..20,00. C!_.
I'I~C DAIVIAGE.!^"y one "~ .~ :L, O_~_~! 000.
MEO_ 0(1' (Anyon" p<:l90n) . ... _~ .!) , 00.0.
PEHSONAL & ADV INJURY $ '~.!..~OO r ()()Q
CEr>lERALAGGRECATE $:~!. 0.0.0.,0.0.0..__..
PROOucm . COMPIOP AGG ~.2 I () 0 ~ ' 0.0.0.
'-
!)~~N"_ A,CCKI'C",ATC LIMIT A?PLI!:S f'Eft
: I' !PRO-L'
: POLICY, . JI"r.T LOC
.~U"'OMODILE LIAlillLlTY
~\
X A:O>Y AUTO
1 ALL OWNI'P AUTOS
I $C1ICDULI:L> AUTOS
: ~",,:D AUTOS
: ~()r,.()WNED AUTOS
H08123032
01/01/03
01/0.1/04
COMDINCD SINCLE LIMIT
lEa ~CCldon()
s 50.0.,00.0.
OODIL Y INJURY
: (Po, pel'llon)
j-
I BOOIL Y INJURY
I I rer 9CC1ne:nl)
s
Is
I
PRcrEKTY DAMAce
(Pel accldont)
~
AUTO Or>ll Y , CA ACClLo~NT
GARAGE "lABILITY
I ANY AUIO
i EXCl<.$S LIABILITY
I ~ OCCUK I 'J CLAIM; MADE
I
EACH OCCURRI::NCF
ACCKEGATC
EA ACC $
AGG $
$
OTHeR THAN
AUTO ONLY:
I 01: (I(JCTIDL[;
I rU:1f.',NTlON
i WORKERS COMPENSA110N A~ D
EMpr.OVtRS' LIAElI"IYY
$
$
$
B
WC1:Z2734
01/01/03
01/0l/04
$ 100000
... - ' ."
e.LDIS[;ASE-tiAEMPLOVE $100000
E." OI!':CAS" - POLICY liMIT $ 500.0.00
OTHl:R
c
p~operty
NAc1358525
01/01./03
01/01/04
PER
ON FILl::
POLICY
-!O::~;'.:RI"TION OF OPERATIONSIr.OC ~TION5IV"HICLE.5IEXCr.uSlONS ADDED BY ENDO~Er.II[NT/SI"E:CIAL PROVISIONS
:::"~:::'t:_ficate holde:l:' i5 an a.dditional :i.nsux-e4 for general liability only wieh
regard to SandeX"ljn Center Playground ~~Clearwater, FL
,-..; ~T!FICA TE HOLOER
I
Y i AOQl'l'lONAL INSUREO: INSUIQiR LETTER:
CITYOFC SHOU"O ANV OF THE ABOVE DESCRIBEO POLl\;I"S BE: CANCEr.LEO E CFORE THE '::XPIRATION!'
DAT~ T~E:REOF, THE ISSUING INSURER WILL ENtl~AVOR TO NIAlL _~.O._ OA"l$ WRiTIGl
NOTICE YO THE CliRTIFICATE HOI.OSR NAMED TO TH[; LEFT, ",uY FAI LURE TO 00 SO SHALl. !
IMf'OSE NO OBLlGAl'lON OR LIABlI.ITV 01' ANY KINO UPON THE INSU!tLR,' ,~,.,,~ ~ I
REPREsl<.NYA T1VES.
AUT D RESENT VE ~
<t:lACORD CORPORATION 1988
CANCELLA lION
City of Clearwater
~ublic WOXKS ~aministration
~.O. l30~ 4748
Clea;tWate:r: FL 33758-4748
- I
ACORD 25.$ (1/97)