CERTIFICATE OF LIABILITY INSURANCE (5)
ACORD,.
CERTIFICATE OF LIABILITY INSURANC~A8&~~ s DA~E~~~~r:o~
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
The Connelly Insurance Group
630 Chestnut Street
P.O. Box 2456
Clearwater FL 33757-2456
Phone: 727-46l-6044 Fax:727-442-7695
INSURERS AFFORDING COVERAGE
INSURED
Head Start Child Development
& Family Services
6698 68th Avenue, North #D
Pinellas Park FL 33781-~063
INSURER A: Ace American Insurance
INSURER B: Amerisure Insurance
INSURERC; Great American Ins. Co. of NY
INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
~f~1 TYPE OF INSURANCE POLICY NUMBER b~~lfrMM/DDiYYi . I P~kf~1~r~W'J:.?N LIMITS
M: UA"un EACH OCCURRENCE $1,000,000
A X, COMMERCIAL GENERAL LIABILITY G20400869 01/01/03 01/01/04 FIRE DAMAGE (Anyone fire) $1,000,000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5,000
1--1. PERSONAL & ADV INJURY $1,000,000
I-~'-'-'-'
j I GENERAL AGGREGATE $2,000,000
!~-E~'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
II nPRO. n
, POLICY JECT LOC
: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
r-- $ 500,000
A ~ ANY AUTO H08123032 01/01/03 01/01/04 (Ea accident)
I ALL OWNED AUTOS BODILY INJURY
'- (Per person) $
SCHEDULED AUTOS
-
HIRED AUTOS BODILY INJURY
- $
NON.OWNED AUTOS (Per accident)
F PROPERTY DAMAGE $
(Per accident)
I GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
: 1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
I EXCESS LIABILITY EACH OCCURRENCE $
:=J OCCUR D CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
1'RETENTION $ - $
WORKERS COMPENSATION AND I TORY LIMITS I IUE~-
B EMPLOYERS' LIABILITY WC122734 01/01/03 01/01/04 $ 100000
EL. EACH ACCIDENT
.-"---'- " --- -- ..'--.- .-1-- --~~---- ---- E.L~ D!~i=^~i= .-.-EA-EI\:U?!..O'!5-E -$--1-00-0-0- 0 ___"" .._m___
- .-- ---
EL. DISEASE - POLICY LIMIT $ 500000
! OTHER
C I Property MAC1358525 01/01/03 01/01/04 PER POLICY
ON FILE
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER I Y I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION ~
CLEAR24 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE C1~ELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVO~ MAIL ..3L DAYS WRITTEN
City of Clearwater \-,
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE 'fJr' BUT FAILURE TO DO SO SHALL
Housing & Urban Development IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND Ufl&l THE INSURER, ITS AGENTS OR
112 S. Osceola Avenue J,:;'
Clearwater FL 33758 REPRESENTATIVES. .:-:1;::
AUTHO T17RESENtjE ~ ~~'
I ,
,~,
ACORD 25-5 (7/97) ~ ~ACORD CORPORATION 1988