CERTIFICATE OF LIABILITY INSURANCE (3)
ACORDN
CERTIFIC
E OF LIABILITY INSU
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~PARC-1 12/05/01
THIS CERTIFICATE I I UED 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.
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DATE (MMlDDIYY)
PRODUCER
BOUCHARD-STARCREST ,
101 STARCREST DRIVE
POBOX 6090 .(
CLEARWATER FL 33758-6090
Phone:727-447-6481 Fax:727-449-1267
INSURED
INSURERS AFFORDING COVERAGE
UPARC Inc
1501 North Belcher Road
Clearwater FL 33765-1302
INSURER A:
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
FIREMAN'S FUND INSURANCE CO
BRIDGEFIELD EMPLOYERS 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.
I~: TYPE OF INSURANCE POLICY NUMBER LIMITS
GENERAL LIABILITY
A X COMMERCIAL GENERAL LIABILITY MXG 8 0 7 924 7 8
CLAIMS MADE [!] OCCUR
12/01/01
EACH OCCURRENCE $ 1000000
12/01/02 FIRE DAMAGE (Anyone fire) $200000
MED EXP (Anyone person) $ 10000
PERSONAL & ADV INJURY $ 1000000
GENERAL AGGREGATE $ 3000000
PRODUCTS - COMP/OP AGG $3000000
Em Ben. 1000000/3
COMBINED SINGLE LIMIT
12/01/02 (Ea accident)
BODILY INJURY
(Per person)
LOC
A X ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
X HIRED AUTOS
X NON-OWNED AUTOS
MXA80228159
12/01/01
GARAGE LIABILITY
ANY AUTO
BODILY INJURY
(Per accident)
I PROPERTY DAMAGE
(per accident)
AUTO ONL Y - EA ACCIDENT $
$
EXCESS LIABILITY
A X OCCUR 0 CLAIMS MADE
OTHER THAN
I AUTO ONLY:
EACH OCCURRENCE
EA ACC $
AGG $
$ 1000000
XYZ96771761
12/01/02
AGGREGATE
$
DEDUCTIBLE
X RETENTION $ 0
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
083024870
04/01/01
X TORY LIMITS
04/01/02 E.L EACH ACCIDENT $ 1000000
E.L. DISEASE. EA EMPLOYEE $ ~O 0 0 0 C 0
E.L. DISEASE - POLICY LIMIT $ 1000000
B
OTHER
I
DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
kh/asst
CERTIFICATE HOLDER
i N I ADDITIONAL INSURED; INSURER LETTER:
CANCELLATION
CITY OF CLEARWATER
PARKS AND RECREATION DEPT
100 S MYRTLE AVE #C-110
CLEARWATER FL 33756-5520
XCITYOF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ...lL 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
TIVES.
EP SENTA
ACORD 25-S (7/97)
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@ ACORD CORPORATION 1988
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