CERTIFICATE OF LIABILITY INSURANCE (8)
ACORDm
CERTIFICATE OF LIABILITY INSURANC~A8G~~ S DA~~~~~~)3
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
Brown & Brown Insurance
. 30 Chestnut Street
P.O. Box 2456
Clearwater FL 33757-2456
Phone: 727-461-6044 Fax:727-442-7695
INSURERS AFFORDING COVERAGE
INSURED
Head Start Child Development
& Family Services
6698 68~h Avenue, North #D
Pinellas Park FL 33781-5063
INSURER A: Landmark American Ins. CO.
INSURER B: Ace American Insurance
INSURER C: Amerisure Insurance
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.
INSR TYPE OF INSURANCE POLICY NUMBER b~flfrM~5mYE I P.9.Ll9.Y EXPlf!.'!T~?N LIMITS
LTR DATE'(MM/DDIYY
~NERAL LIABILITY EACH OCCURRENCE $ 1,000,000
B X COMMERCIAL GENERAL LIABILITY G20400869 01/01/04 01/01/05 FIRE DAMAGE (Anyone fire) $100,000
'. - .-lce-LAlMS-MA~ -oCC-t!R "' , . .. - -"_._----"- .. --. ----- ----- - ,- , ." - "" , -_.-- MliiB-EXP (Any.<lfle-pe;-son)' "'$"57 ~---~~
PERSONAL & ADV INJURY $1,000,000
-
GENERAL AGGREGATE $2,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
I n PRO- nLOC
POLICY JECT
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $500,000
B ..!.. ANY AUTO H08123032 01/01/04 01/01/0S (Ea accident)
- ALL OWNED AUTOS BODILY INJURY
(Per person) $
SCHEDULED AUTOS
-
HIRED AUTOS BODILY INJURY
- $
NON.OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
~ -- ---..-.. (Per accident)
, -,,-
i i I ~I;' (.'; " AUTO ONLY.. EA ACCIDENT $
GARAGE LIABILITY
~ ANY AUTO I . EA ACC $
: l OTHER THAN
"\ AUTO ONLY:
.. r AGG $
EXCESS LIABILITY ..' ,j :,1 EACH OCCURRENCE $
=:J OCCUR D CLAIMS MADE I AGGREGATE $
L_.._
CITY C:~ :~~'._ ~:, $
~ DEDUCTIBLE rl![JIIC,','U:~.S 'd.. .. " : ;,,~: i; -,', $
---.- -.
RETENTION $ $
WORKERS COMPENSATION AND X I r6Wd~YTS I IOJr-
ER
~- EMPLOYERS' LIABILITY WC122734 n, In, InJJ. .. ,Q.1JOl../Os. ..E.LEAf'H ""('IDENT $100000
-- -,- ~ 1-
- -- -. --~- " -----.-----
E.L. DISEASE - EA EMPLOYEE $ 100000
E.L. DISEASE.. POLICY LIMIT $ 500000
OTHER
A Property Section LHD332417 01/01/04 01/01/05 Per Policy
on File
DESCRIPTION OF OPERATlONS/LOCATlONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate holder is an additional insured for general liabili ty only with
regard to Sanderlin Center Playground - 918 Palmetto Street, Clearwater, FL
CERTIFICA TE HOLDER I y I ADDITIONAL INSURED; INSURER LETTER: A CANCELLATION
CITYOFC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
City of Clearwater NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
ATTN Earl Barrett IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O. Box 4748
Clearwater FL 33758-4748 REPRESENTATIVES.
1 AUTH07i..D 17RESENrJE ~
AC RD 25-S 7/97 €-/ c
o
@ACORDCORPORATION 1988