CERTIFICATE OF LIABILITY INSURANCE (10)
ACORDN
CERTIFICATE OF LIABILITY INSURANCE
OP ID S DATE (MM/DDIYYYY)
HEADS-2 12 21 04
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
17757 US Highway 19 N, Ste 660
P.O. Box 2456
Clearwater FL 33757-2456
Phone: 727-461-6044 Fax:727-442-7695
INSURED
INSURERS AFFORDING COVERAGE
NAlC#
Head Start Child Development
& Family Services
6698 6.8th Avenue, North, #D
Pinellas Park FL 33781-5063
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
Ace American Insurance
Amerisure Insurance
Landmark American Ins. Co.
19488
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.
LTR NSRC TYPE OF INSURANCE POLICY NUMBER PD~,;!~jri~J8~E Pgk~CEYI~rXb~~~N LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
-
A X COMMERCIAL GENERAL LIABILITY G20400869 01/01/05 01/01/06 ~~~~;s~s (Ea occurence) $100,000
f-- -.J CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $5,000
PERSONAL & ADV INJURY $1,000,000
I---
GENERAL AGGREGATE $2,000,000
f--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
!xl n PRO- nLOC
X POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
f-- $500,000
A ANY AUTO H08123032 01/01/05 01/01/06 (Ea accident)
I---
ALL OWNED AUTOS BODILY INJURY
f-- $
X SCHEDULED AUTOS (Per person)
I---
.!.. HIRED AUTOS BODILY INJURY
$
X NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
:=J OCCUR D CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND xl TORY LIMITS I IUJ~-
B EMPLOYERS' LIABILITY WC132273405 01/01/05 01/01/06 $100,000
ANY PROPRiETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
"OFFrCERlMEMBEl'<"EXCLt:J0ED"7 .' -.-- ----,--- -_._-----~- --"- --"-,---- .. . ---- - - E.L~-eA~MPWY-EE -$--J..OO,OOo.
,,,,,,
II yes, describe under $500,000
SPECIAL PROVISIONS below E.L. DISEASE. POLICY LIMIT
OTHER
C Property LHD332417 01/01/05 01/01/06 On File with
company
DESCRIPTION OF OPERATIONS f LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
'04 DEe 22 F'Ml:3G
CERTIFICATE HOLDER
CANCELLATION
City of Clearwater
Housing & Urban Development
112 S. Osceola Avenue
Clearwater FL 33758
CLEAR24 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
ACORD 25 (2001/08)
VE~
@ACORDCORPORATION 1988