CERTIFICATE OF LIABILITY INSURANCE (4)
ACORD~
CERTIFIC
E OF LIABILITY INSU
ANCC OPID D
~PARC-1 03/21/02
THIS CERTIFICATE IS r.sSUED 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.
DATE (MMlDDIYY)
PRODUCER
BOUCHARD-STARCREST
101 STARCREST DRIVE
POBOX 6090
CLEARWATER FL 33758-6090
Phone:727-447-6481 Fax:727-449-1267
INSURERS AFFORDING COVERAGE
INSURED
UPARC Inc
1501 North Belcher Road
Clearwater FL 33765-1302
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
FIREMAN'S FUND INSURANCE CO
BRIDGEFIELD CASUALTY INS CO
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 ~~~~rM~~t~YE P~.k+~~~~r6~J}?N LIMITS
LTR
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
A Xl COMMERCIAL GENERAL LIABILITY MXG80792478 12/01/01 12/01/02 FIRE DAMAGE (Anyone fire) $ 200000
__J CLAIMS MADE ~ OCCUR , $ 10000
MED EXP (Anyone person)
--.
PERSONAL & ADV INJURY $ 1000000
-
GENERAL AGGREGATE $ 3000000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG $ 3000000
"I "I PRO- nLOC Emp Ben. 1000000
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $ 1000000
A X ANY AUTO MXA80228159 12/01/01 12/01/02 (Ea accident)
-
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS ~. (Per person)
- i
X HIRED AUTOS BODILY INJURY
- $
~ NON-OWNED AUTOS (Per accident)
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
=1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $ 1000000
A ~ OCCUR D CLAIMS MADE XYZ96771761 12/01/01 12/01/02 AGGREGATE $
$
::::l DEDUCTIBLE I $
X RETENTION $ 0 , $
WORKERS COMPENSATION AND , 04, / 0 1 / Q 2 l~n_.Q.1 LQJ,[o 3 X I TORY LIMITS I IUI'H-
ER
B EMPLOYERS' LIABILITY 083024870 .$ ~OO-OOOO----
E.L, EACH ACGillENL__ ---'-
~~" -.------- ---, --~.--_. ---- - --
- ---- -1- E.L. DISEASE. EA EMPLOYEE $ 1000000
E.L. DISEASE - POLICY LIMIT $ 1000000
OTHER
DESCRIPTION OF OPERATlONS/LOCATlONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
SUBROGATION AGAINST CITY OF CLEARWATER SHALL BE WAIVED AS RESPECTS WORKERS
COMPENSATION AND EMPLOYERS LIABILITY INSURANCE EXCEPT IN MATTERS SHOWN BY
FINAL JUDGEMENT TO HAVE BEEN CAUSED BY SOLE NEGLIGENCE OF CITY OF
CLEARWATER.
CERTIFICATE HOLDER I N I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
XCITYOF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL .:J.L DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
CITY OF CLEARWATER *
100 S MYRTLE AVE IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
CLEARWATER FL 33756-5520 REPRESENLA TIVES.
I AUTHOR~ :Py~
ACORD 25-S (7/97) Cz. ~ d<!:.: r~~ ..~ ' ~'g /lll.. @ACORDCORPORATION 1988
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