CERTIFICATE OF LIABILITY INSURANCE
1....
ACORDTM
CERTIFICATE OF LIABILITY INSURANCE
PDL DATE
P4SA 03-02-2005
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
ACORDIA SOUTHEAST-CLEARWATER/PHS
224347 P: (866)467-8730 F: (877)538-8526
P. O. BOX 29611
CHARLOTTE NC 28229
INSURERS AFFORDING COVERAGE
INSURER A: Hartford Fire Ins Co
INSURED
LE-AZON TECHNOLOGY INSTITUTE INC.
1250 PALMETTO STREET
CLEARWATER FL 33756
COVERAGES
INSURER B:
INSURER C:
INSURER D:
INSURER E:
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 Id]Nn::tfg~v.fi "g~/fN.ftJ~~J!r~'! LIMITS
LTR
~NERAL LIABILITY EACH OCCURRENCE $1,000,000
A f-- OMMERCIAL GENERAL LIABILITY 21 SBA NVOO05 02/18/05 02/18/06 FIRE DAMAGE (Anyone firel $300,000
f-- CLAIMS MADE [ZJ OCCUR MED EXP (Anyone person) $10,000
X BuslnessLla]:5 - - PERSONAL & ADV INJURY d~OOO, 000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREn LIMIT AP~ PER: PRODUCTS - COMP/OP AGG $2, 000, 000
n PRO- X
POLICY JECT LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
f--
f-- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
f--
- HIRED AUTOS BODILY INJURY
$
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 LIABILITY EACH OCCURRENCE $
~- OCCUR D CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSA TION AND I TVX~JT ~J.~;,l IOni-
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT $
E,L. DISEASE - EA EMPLOYEE $
E,L, DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERA TIONS/LOCA TIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Those usual to the Insured's Operations. Certificate holder is also an
Additional Insured per the Business Liability Coverage Form SSOO08.
CERTIFICATE HOLDER I X I ADDITIONAL INSURED: INSURER LETTER: A CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
City of Clearwater 30 DAYS WRITTEN NOTICE (10 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE
Earl Barrett/Engineering Dept. 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
P.O. Box 4748 REPRESENT A TIVES,
Clearwater, FL 33758-4748
AUTHORIZED REPRESENT~
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ACORD 25-S (7/97)
@ ACORD CORPORATION 1988