CERTIFICATE OF LIABILITY INSURANCE
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ACORD~ :qI$.F{rl:FlyAT~ .QF .qIA13.I:pnF)'...IN$QRAfJQ~iJ~~~2............ DA;~7~f;~~Y~
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Connelly Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
630 Chestnut Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 2456 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater FL 33757-2456 COMPANIES AFFORDING COVERAGE
Jack Lee COMPANY
Phone No. 727-461-6044 Fax No. 727 -442 -76 95 A Fireman's Fund Child Care
INSURED COMPANY
B Michigan Mutual Insurance Co.
Head Start Child Development COMPANY
& Family Services Inc C
6698 68th Avenue, North, #D COMPANY
Pinellas Park FL 33781-5063 D
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THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE (MMlDDIYY) DATE (MMfDDIYY)
GENERAL LIABILITY GENERAL AGGREGATE $2,000,000
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A X COMMERCIAL GENERAL LIABILITY 815MXG80752638 01/01/01 01/01/02 PRODUCTS - COMP/OP AGG $2,000,000
I CLAIMS MADE ~ OCCUR PERSONAL & ADV INJURY $1,000,000
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $1,000,000
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...!. Mu1ticover FIRE DAMAGE (Anyone fire) $100,000
MED EXP (Anyone person) $5,000
AUTOMOBILE LIABILITY
- COMBINED SINGLE LIMIT $500,000
A ~ ANY AUTO 815MXG80752638 01/01/01 01/01/02
I-- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
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I-- HIRED AUTOS BODILY INJURY
$
NON-OWNED AUTOS (Per accident)
I---
I-- PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $
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ANY AUTO OTHER THAN AUTO ONLY: I.
I--
EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $
R UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM $
"" .-- WORKERSCOMPENSATIONAND . . --".-'.-- - --.- ,- .. . .... '"..', . '..-.'-" .' 'XI'vVCSTATU- I IO~lt ./.~.;
TORY LIMITS '.'
EMPLOYERS' LIABILITY
EL EACH ACCIDENT $100,000
B THE PROPRIETOR! MINCL WC132273400 01/01/01 01/01/02 EL DISEASE - POLICY LIMIT $500,000
PARTNERSfEXECUTIVE
OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE $100,000
OTHER
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DESCRIPTION OF OPERATIONSfLOCATIONSNEHICLESfSPECIAL ITEMS JL yJ4N 2 9200r I ~I
Loc: 918 Palmetto St, Clearwater, FL (Sanderlin Center Playground) .
of Clearwater is additional insured for general liability.
CITY Of ClEMf,if.~ r rR-J
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· CjSR!IFtCATE:r.lOtpE:R:.. .....'.'.........::..:....::......:.:.:::::.:.:.:......:.:................:....::........:....:.:.. CANCELLATION... . . . . . . . . . . . . . . I . . . .v . ...... . : -""';i~RATION
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! CITYC-2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
I City of Clearwater
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
Public Works Admin ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
ATTN: Earl Barrett
P 0 BOX 4748 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
Clearwater FL 33758-4748 OF ANY KIND \.IPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED :t ESENTATIVE, L--
Jack Lee ~~
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