CERTIFICATE OF LIABILITY INSURANCE (3)
A CORaM
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YY)
10/07/04
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
ACORDIA EAST - TAMPA BAY
P.O. Box 31666
Tampa, FL 33631-3666
727-796-6666
INSURERS AFFORDING COVERAGE
INSURED
PACT, Inc., Performing Arts
Center Foundation, Inc.
1111 McMullen Booth Road
Clearwater FL 33759
COVERAGES
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
ZURICH-AMERICAN-09593
ZENITH INSURANCE CO-DB
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,
l~iJl TYPE OF INSURANCE POLICY NUMBER h~ffJ.Et5<;;~X.~ Pg~If"Y,~r:)~~JJ~N LIMITS
A GENERAL LIABILITY CP0278060501 10/01/04 10/01/05 EACH OCCURRENCE $ 1000000
e-
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE IAny one fire) $ 100000
I CLAIMS MADE W OCCUR MEO EXP (Anyone personl $ 10000
- PERSONAL & ADV INJURY $ 1000000
- GENERAL AGGREGATE $ 2000000
~'L AGGREGATE LIMIT AP~ PER: PRODUCTS - COMP/OP AGG $ 2000000
POLICY n ~~gT X LOC
A ~OMOBILE LIABILITY CP0278060501 10/01/04 10/01/05 COMBINED SINGLE LIMIT
$ 1000000
ANY AUTO lEa accident)
-
- ALL OWNED AUTOS BODILY INJURY
$
~ SCHEDULED AUTOS (Per person)
~ HIRED AUTOS BODILY INJURY
$
~ NON-OWNED AUTOS (Per accident)
- PROPERTY DAMAGE $
(Per accident)
RAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A EXCESS LIABILITY UMB937678901 10/01/04 10/01/05 EACH OCCURRENCE $ 10000000
Q OCCUR D CLAIMS MADE AGGREGATE $ 10000000
$
==1 DEDUCTIBLE $
RETENTION $ $
B WORKERS COMPENSATION AND Z836094211 1/01/04 1/01/05 I WC STATU- I 10TH-
X TORY LIMITS ER
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT $ 1000000
E,L. DISEASE - EA EMPLOYEE $ 1000000
E,L. DISEASE - POLICY LIMIT $ 1000000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
PROOF OF GENERAL LIABILITY
* 1 0 DAYS NOTICE OF CANCELLATION APPLIES FOR NON PAYMENT. *
CERTIFICATE HOLDER 1 I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF CLEARWATER, PARKS & DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
RECREATION ATTN: DEBBIE REID NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
100 S. MYRTLE AVE IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
CLEARWATER FL 33758 REPRESEI'ifATIVES. )
AUTb _ A1/( t:[Q(
- r'" ~
ACORD 25-5 (7/97)
46- 64
@ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s),
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25-5 (7/97)