CERTIFICATE OF LIABILITY INSURANCE (7)
~'
-'N-~8-2003 14:41 FROM:
TO,7275624755
P.OD2/DDC'
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CERTIFICATE OF LIABILITY INSURANC~:!~ s DA~Edi~~~)2
THIS CERTIFICATE IS ISSUED AS A MAnER OF IIIIFOI~MATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERnFICATE DOES NOT AMEND, Ex'rEND OR
AL 1'ER THE COVERAGE AFFORDED 8Y THE POLICIE:S BELOW.
i ',,9f;_ORD.
PRODUC ER
'l'he Connelly Insunmce Group
630 Chestnut Stre~lt:.
,P.O. BOx 2456
: Cl$arwater FL 337!.7-2456
lI?hone.:727-461~60U F&x:727-442-7695
'INS'JRED .... -.."
INSURERS AFFORDING COVERAGE
Ace Ameri~~ Insurance
ADerisure InSurance
Great American Ins. Co. of
INSuRJ:~ A;
INSURER,B~
IN~ER C:
INSUReR 0:
INSUReR E:
Head Start Child Development
, Fam1ly Ee~ices
6698 68th Avenue, North #D
Pinellas Iark FL 33781-~063
I
NY
COVERAGES
r T'1E POLICIES OF IN~RANCE U~ TED BELOW HAVE BEEN ISSUED TO Ttii:lINSUlttO NAMED AlilOVE FOR TH[ POLICY peRIOD INDlCATEiD, NOTWITNSTANDING
l ~'NR~OUIREMENr, 'rERM ORC( ,NDITION OF ANY CONTRAcr OR OTI1ER DOCI.IM~NT WITH RESPEcr TO WHICH THIS C~RTIFICA TE MAY BE ISSuED OR
~" MAY PERTAIN, THE INSURANCE 1 FFORDED BY 'ttiE PO~ICIES OESCRIBI;D H~RE:IN 1$ SUBJe.CT 'ro ALL THE T~RMS. [D(CLu510NS AND CONDITIONS OF SUCl'j
f>OLICI~S, AGGREGATE LIMITS 5110WN MAY HAV~ B~CN REDUCe.o By PAID ClAIMS,
,.;'~r""." TYpeOFINSURANC!; ". POuCYNUMDER '~~~-'iE"MMIDDIVY DATEIMMr6~~?lif LIMITS ....
r ": G~N"RAL LIABIL1'I'Y EACIol OCCI,IRRSNCI; .." ! .1_1000, 000
! "IXiCOMMEiRCIALG~N[RALLlABILlTY G20400869 01/01/03 01/0.1/04 f'IREOAMAGE(AnYOn~fir~) 'l,OOO/.O~
~i ...JCLAIMS MAD!: ~] OCCUR ~~~ .!.A..!'y one person) ~. 5, 000 _, . , .1
H-....,-- PERSONALa<AOVINJURY ...:,1,000,000 -1
L-J . .___ GENeRALAGGREGAIE 1:,2 r 000 '.9.og__~_
i GEN:LACOREGATEi LIMIT APF LIES PER: PRODUCTS. COMP/?P~~ "2,000,000 __
L-: I POLlcD ~~8i [ II.0c
I' i, AUTOMOBILE L1ABILll"Y
A iXl ANY AUTO
CJ ALL OWNED AUrOS
L SCHEDULED AUTOS
L ,. ,/" HIRED AUTOS
NON-OWNED Au'I'OS
H08123032
01/01/03
01/01/0.
COM8IN!;DSINGLE LIMIT
(EOI acQdenl)
BOOIL Y INJURY
(Pe, ptlf"Son)
BOOn. Y INJURY
(Per acCIdent)
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PROPERTY DAMAGE
(Par scdclentl
Aulo ONLY - EA ACCIDENT
GARAel': LIAelL.ITY
,=l ANY AUTO
I EXCESS ~IABILIl"Y
!i OCCUR 0 CLAI Y1S MACE
,-
or tieR TtiAN
AUTO ONLY:
EAACC
AGG
EACH OCCURR~NCC
AGGREGATE
>
L I oeouClIBLE
: I RETeNTION $
i WORK(RS COMPENSATION. _NO
I EMPLOYERS' L1ABII.ITY
I
LJil?~x.LlMlisl,_ IOJ~'
01/0],/04 e,L, EACH ACCID~NT
EL DISEASE. EA EMP~OYEE
~~ ~;~~SE. POLI~Y LI.~"!:.
,100000
. ;.190000
,500000
01/01/03
WC122734
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0J./OJ./04
PER
ON FILE
POl.!CY
01/01/03
HAC1358525
" Do::3CRIl'TION OF OPERATlOIli$/LO :ATIONSNeHICU;SI!XCI.USIONS ADDED BY ENDORSEMENTISPECIAI. PROVISIONS
Certifica~~~tional insured for general liability only
I. r.~.... 00 ...: . ,,' ea....O... 7L
CERTIFICATE HOJ.DER I l' I Alll)l'rlONAL INSURED; INSUReR LeTTI!It;
!
i
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ACO~D25.S (7/97)
with
CANCELLAnON
C:ETYOi'C
SHOUIJ) ANY 01' TH!! ABO\/! D1!$CRlBI!I) "oua~s BE CANCELLED EEFORE TIli! EXPIRA lION
I)A'l'li THEREOf', THI! ISSUING INSUREA WILL ENDEAVOR TO MAIL _3.0- I)AYS WRI'n'~N
NOTICE TO THE CERT1ACATE HOLOER NAMel) TO THE LEFT. Ilur f"PJLURE: 10 DO SO SHALL
IMPOSE NO OBLIOATION OR i.1A1llU'fY OF.ANY KIND UPON THE INSUllER, ITS AGENTS OR
REPRESENT ATlVliS.
AUTHOrr '7}RESENrr Q.O.~ ()+:
c.,. @ACORD CO ~PORA TION 1988
City of Clearwater
P.O. BOx -1748
clearwate::- Ii'L 33758-4748