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INSURANCE CERTIFICATES FOR PREVIOUS YEARS INCLUDED J 1 City of Clearwater Interdepartment Correspondence Sheet COPIES: Susan Stephenson, Documents & Records Supervisor Earl Barrett, Real Estate Services Manager ~E eEl V E D Leo Schrader, Risk Manager DCr 06 1997 TO: FROM: SUBJECT: Insurance Certificate - Pinellas County Arts Council elTV t~l 1::':1::';. . . 'Jl8....o..;,nK DEPr. DATE: October 6, 1997 Attached is an original Certificate ofInsurance provided by Frank L. Massaro, Jr. detailing coverage limits of the Commercial General Liability insurance policy Allstate has issued to the Pinellas County Arts Council in compliance with lease provisions governing its use of City property at 400 Pierce Boulevard. The insurance coverages run from 10/01/97 through 10/01/98, The only change from the previous policy term is the certificate holder addressee. This policy, together with the certificate sent to you on 10/03/97 detailing building insurance provided by Lloyds of London, should satisfy all insurance requirements of the current lease agreement. AlIs1-atlr ' . CUSTOMER NUMBER: 9~02984 RUN tATE: 10-01-97 CERTHOLDER IPKG/MONOl 010 49 649518 19 00 003 CITY OF CLEARWATER ATTN E BARRETT ENGINEERNG DEPT PO BOX 4748 CLEARWATER, FL. 33758-4748 BOOTH: AE6 PLRO: 41 OPER ID: BJH --.... : " ~: (i\J i~ .. '~&1 lL .,," \\\,~~r:;-. ~ _ ~- S..9-r Wu.\ '\. ~.'.'.' ..", ::'.'''',c- c;:; " " ' , , ll' r-. ll' c <Xl N III )0- w :.: I- z 1-4 0::: ll. W a:: II III III BU114.2 YOU'RE IN GOOD HANDS WITH ALLSTATE@ l AlIstatlf I I ALLSTATE INSURANCE COMPANY HOME OFFICE. NORTHBROOK, ILLINOIS CHANGE ENDORSEMENT Effective Date of Change: 10/01/97 Change Endorsement No. 001 THIS ENDORSEMENT FORMS A PART OF THE POLICY NUMBERED BELOW: 1. Policy Number: 49649518 2. Named Insured: PINELLAS COUNTY ARTS COUNCIL 3. Changes: IT IS HEREBY AGREED THAT THE FOLLOWING IS ADDED AS AN CERTIFICATE HOLDER TO THE POLICY. CH -CITY OF CLEARWATER - A1TN EARL BARRETT ENGINEERING DEPT. POBOX 4748 CLEARWATER FL 33758-4748 ALL OTHER TERMS AND CONDITIONS REMAIN THE SAME. 4. Changes in Premium: The above amendments result in a change in the premium as follows: TO BE nn NO D ADJUSTED L-J CHANGE AT AUDIT ADDITIONAL PREMIUM $ RETU RN PREMIUM $ IN WITNESS WHEREOF, Allstate has caused this endorsement to be signed by its Secretary and its President at Northbrook, Illinois, ~/~ ~It/.~ Robert W. Pike Secretary Robert W, Gary President, Commercial Lines Countersigned By FRANK l MASSARO SR ,Authorized Agent BU126 (Ed, 8~89) II BU114-2 YOU'RE IN GOOD HANDS WITH ALLSTATE@ , AlIstatff CERTIFICATE OF INSURANCE I8J ALLSTATE INSURANCE COMPANY D ALLSTATE INDEMNITY COMPANY D ALLSTATE TEXAS LLOYDS 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, CERTIFICATE HOLDER NAMED INSURED Name and Address of Party to Whom this Certificate is Issued Name and Address of Insured CITY OF CLEARWATER PINELLAS COUNTY ARTS COUNCIL ATTN E BARRETT ENGINEERNG DEPT 501 CENTRAL AVE PO BOX 4748 SAINT PETERSBURG CLEARWATER FL 33758-4748 I I FL 33701-3727 This is to certify that policies of insurance listed below have been issued to the insured named above subject to the expiration date indicated be- low, 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, TYPE OF INSURANCE AND LIMITS Policy Effective Expiration COMMERCIAL GENERAL LIABILITY Number 49649518 Date 10/01197 Date 10/01/98 Limit Amount GENERAL AGGREGATE L1MIT(Other than Products-Completed Operations) $ 1,000,000 PRODUCTS-COMPLETED OPERATIONS AGGREGATE LIMIT $ 1,000,000 PERSONAL-ANDADVERTiSIN-G INJURYUMIT . $ ... .. .... 500,000 ... EACH OCCURRENCE LIMIT $ 500,000 PHYSICAL DAMAGE LIMIT $ 50,000 ANY ONE LOSS MEDICAL EXPENSE LIMIT $ 5,000 ANY ONE PERSON WORKERS' COMPENSATION & Policy Effective Expi ration EMPLOYERS' LIABILITY Number Date Date Coverage Limits WORKERS' COMPENSATION STATUTORY - applies only in the following states: BODILY INJURY BY ACCIDENT $ EACH ACCIDENT EM PLOYERS' BODILY INJURY BY DISEASE $ EACH EMPLOYEE LIABILITY BODILY INJURY BY DISEASE $ POLICY LIMIT Policy Effective Expiration AUTOMOBILE LIABILITY Number 49 649518 Date 10/01197 Date 10/01/98 Coverage Basis Limits ANY AUTO OWNED AUTOS HIRED AUTOS Combined Single Limits of Liability BODILY INJURY & PROPERTY DAMAGEI$ 500,000 I EACH ACCIDENT SPECIFIED AUTOS X NON-OWNED AUTOS Split Liability Limits Bodily Injury Property Damage Each OWNED PRIVATE PASSENGER AUTOS $ PERSON OWNED AUTOS OTHER THAN PRIVATE PASSENGER $ $ ACCIDENT UMBRELLA LIABILITY Policy Number Effective Date Expiration Date EACH OCCURRENCE I GENERAL AGGREGATE I PRODUCTS-COMPLETED OPERATIONS AGGREGATE $ I $ I $ OTHER(Show Policy Effective Expirati,on type of Policy) Number Date Date DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS CANCELLATION Number of days notice FRANK L MASSARO SR 10/01/97 Authorized Representative Date Should any of the above described policies be cancelled before the expiration date, the issuing company will endeavor to mail within the number of days entered above, written notice to the certificate holder named above, But failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives. U10523.2 Page 1 of 1 II III BU114-2 YOU'RE IN GOOD HANDS WITH ALLSTATE@ ., ..~ ~ I RECEI"ED OCl 03 1997 I City of Clearwater Interdepartment Correspondence Sheet CITY CLERK DEPT. TO: Susan Stephenson, Documents & Records Supervisor FROM: Earl Barrett, Real Estate Services Manager ~~ COPIES: Leo Schrader, Risk Manager SUBJECT: Building insurance - Haven House (400 Pierce Blvd.) DATE: October 3,1997 Attached is the Certificate of Insurance I received this morning from Nussear Insurance Agency indicating that the Pinellas County Arts Council has obtained $100,000 of building insurance through Lloyds of London on the above referenced City-owned property. This coverage is provided to comply with insurance requirements as stated in the current property lease. On September 3rd I forwarded the Certificate of Insurance from Allstate agent Frank L. Massaro, Jr. detailing the coverage limits of a Commercial General Liability policy obtained through his agency. 1 will ask Leo Schrader to review the certificates and provide comment if the coverages are insufficient in any respect. -. ~ ..... CERTIFICATE OF INSURANCE: I I PRODUCER NUSSEAR INSURANCE AGENCY I CSR JD 10/01/97 I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND I CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE I DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 2380 DREW ST. SUITE. 5 I POLICIES BELOW, CLEARWATER, FL IH - - - - - - - - - - - - - - - - - - H H - H - - - - - - - - - - - - - - - - - - - - - - H - - - - - - - - - - - - - - - - - - - - - - -- I 34625 I COMPANIES AFFORDING COVERAGE I PHONE 813/797 - 8603 I 1-----------------------------------------------------1---------------------------------------------------------------------------1 1 INSURED I COMPANY LETTER A LLOYDS OF LONDON I I 1-------------------------------------------- I m;~H;~O~tta. Arts Council i};m:11g1~i:::::::::_::~~~~\~ql~~ I 1 COMPANY LETTER E I I> COVERAGES <====================================================================================== ==== =========~=-~~~====I I THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABO ~~{~Cp~Fit":MENi I I PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER OCUME~~~~~RR~9 1 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DES N IS SUBJECT TO I ALL TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, I 1---------------------------------------------------------------------------------------------------------------------------------1 co TYPE OF INSURANCE I POLICY NUMBER I POLICY EFF I POLICY EXP I LIMITS I LTR 1 I DATE 1 DATE I I -------------------------------1---------------------------1---------------1--------------1----------------------------------1 GENERAL LIABILITY 1 I I IGENERAL AGGREGATE I 1 1 [------------------- -------------- I !PROD-COMP/OP AGG, I ------------------ -------------- IPERS, & ADV, INJURY 1------------------- -------------- lEACH OCCURRENCE 1------------------- -------------- IFIRE DAMAGE I (ANY ONE FIRE) I ------------------ -------------- I fv1ED. EXPENSE ] COMMERCIAL GEN LIABILITY I I I I I I I I I ! 1m I ] CLAIMS MADE ] OCC, OWNERS'S & CONTRACTOR'S PROTECTIVE (ANY ONE PERSON) AUTOMOBILE LIAB COMB, SINGLE LIMIT ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY BODILY INJURY (PER PERSON) BODILY INJURY (PER ACCIDENT) PROPERTY DAMAGE ------------------------------- ---------------------------1--------------- --------------1------------------- -------------- EXCESS LIABILITY I lEACH OCCURRENCE [ ] UMBRELLA FORM 1 1-------------------1-------------- 1 I [ ] OTHER THAN UMBRELLA FORM ! I I AGGREGATE I 1---1-------------------------------1---------------------------1---------------1--------------1-------------------1-------------- I I I I ISTATUTORY LIMITS I I WORKERS I COMP I I I EACH ACCIDENT I I llNnD I I I DISEASE-POL, LIMIT I I EMPLOYERS I LIAB I I IDISEASE-EACH EMP, I 1---1------------------------------- ---------------------------1---------------1--------------1---------------------------------- +-~,+O'I'RER ---------'~---____r -'--------'-1- ---1------- ~-------- I AI BUILDING B49483 I 10/01/97 110/01/98 I 100,000 I I I 1 I I 1--------------------------------------------------------------------------------------------------------------------------------- I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS I RE:400 PIERCE BLVD.,CLEARWATER, FLORIDA I i I > CERTIFICATE HOLDER <===============================> CANCELLATION <============================================================ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX- PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS TS OR REPRESENTATIVES, I --------------------------------- - ---------------1 = AUTHORIZED REPRESENTATIVE I I CITY OF CLEARWATER ATTN: EARL BARRETT ENGINEERING DEPARTMENT P.O.BOX 4748 CLEARWATER FL 33758-4748 ACORD 25-S (7/90) ROBERT E. NUSSEA .tmstate@ ., CUSTOMER NUMBER: 9JJ2984 RUN Ia.TE: 08-09-97 ADDITIONAL INSURED (PKGlMONOl 010 49 649518 ZO 00 000 CITY OF CLEARWATER PLANNING & URBAN DEVELOPMENT PO BOX 4748 CLEARWATER, FL. 34618-4748 BOOTH: AE6 PLRO: 41 OPERID: DDD RF-C;:- fED ~UG_l 31~ HOUsING 1'.1\1(1 !!:liELOPMENT crr.2~"/ATER co '" co o N III III )0- w ~ I- Z 1-4 a:: D. w a:: II III BU114-2 YOU'RE IN GOOD HANDS WITH ALLSTATE@ / C? ' ('5 il -(J{) (qJ '- . Allstate@ 'I I COMMERCIAL GENERAL LIABILITY CG 20 10 03 97 POLICY NUMBER: 49 649518 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: CITY OF CLEARWATER PLANNING & URBAN DEVELOPMENT PO BOX 4748 CLEARWATER FL 34618-4748 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. CG 20 10 03 97 Copyright, Insurance Services Office, Inc" 1996 Page 1 of 1 BU114-2 YOU'RE IN GOOD HANDS WlTH ALLSTATE@ .~AUstate@ .1 CERTIFICATE OF INSURANCE I [] ALLSTATE INSURANCE COMPANY D ALLSTATE INDEMNITY COMPANY D ALLSTATE TEXAS LLOYDS 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, CERTIFICATE HOLDER NAMED INSURED Name and Address of Party to Whom this Certificate is Issued Name and Address of Insured CITY OF CLEARWATER PLANNING & PINELLAS COUNTY ARTS COUNCIL URBAN DEVELOPMENT 501 CENTRAL AVE PO BOX 4748 SAINT PETERSBURG F L 33701-3727 CLEARWATER FL 34618-4748 This is to certify that policies of insurance listed below have been issued to the insured named above subject to the expiration date indicated be- low, 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, TYPE OF INSURANCE AND LIMITS Policy Effective Expiration COMMERCIAL GENERAL LIABILITY Number 49 649518 Date 10/01/97 Date 10/01/98 Limit Amount GENERAL AGGREGATE L1MIT(Other than Products-Completed Operations) $ 1,000,000 PRODUCTS-COMPLETED OPERATIONS AGGREGATE LIMIT $ 1,000,000 PERSONAL AND ADVERTISING INJURY LIMIT -- $ 500-~000 -.--- -- EACH OCCURRENCE LIMIT $ 500,000 PHYSICAL DAMAGE LIMIT $ 50,000 ANY ON E LOSS MEDICAL EXPENSE LIMIT $ 5,000 ANY ONE PERSON WORKERS' COMPENSATION & Policy Effective Expiration EMPLOYERS' LIABILITY Number Date Date Coverage Limits WORKERS' COMPENSATION STATUTORY - applies only in the following states: BODILY INJURY BY ACCIDENT $ EACH ACCIDENT EMPLOYERS' BODILY INJURY BY DISEASE $ EACH EMPLOYEE LIABILITY BODILY INJURY BY DISEASE $ POLICY LIMIT Policy Effective Expiration AUTOMOBILE LIABILITY Number 49 649518 Date 10/01/97 Date 1 % 1/98 Coverage Basis Limits ANY AUTO OWNED AUTOS HIRED AUTOS Combined Single Limits of Liability BODILY INJURY & PROPERTY DAMAGEI$ 500,000 I EACH ACCIDENT SPECIFIED AUTOS X NON-OWNED AUTOS Split Liability Limits Bodily Injury Property Damage Each OWNED PRIVATE PASSENGER AUTOS $ PERSON OWNED AUTOS OTHER THAN PRIVATE PASSENGER $ $ ACCIDENT UMBRELLA LIABILITY Policy Number Effective Date Expiration Date EACH OCCURRENCE I GENERAL AGGREGATE I PRODUCTS-COMPLETED OPERATIONS AGGREGATE $ I $ I $ OTHER(Show Policy Effective Expiration type of Policy) Number Date Date DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONSISPECIAL ITEMS CANCELLATION Number of days notice FRANK L MASSARO SR 08/08/97 Authorized Representative Date Should any of the above described policies be cancelled before the expiration date, the issuing company will endeavor to mail within the number of days entered above, written notice to the certificate holder named above, But failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives. U10523.2 Page 1 of 1 IIII BU114-2 YOU'RE IN GOOD HANDS WITH ALLSTATE@ AlIstate@ ,- ,. I CERTIFICATE OF INSURANCE I --. EI ALLSTATE INSURANCE COMPANY 0 ALLSTATE INDEMNITY COMPANY 0 ALLSTATE TEXAS LLOYDS 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, CERTIFICATE HOLDER NAMED INSURED Name and Address of Party to Whom this Certificate is Issued Name and Address of Insured CITY OF ST PETERSBURG % DEC, PINELLAS COUNTY ARTS COUNCIL OF INTER GOV RELATION 400 PIERCE BLVD e,?-'1 PO BOX 2842 CLEARWATER . 'ilJl.t,:? FL 34616-5133 ST PETERSBURG FL 33731-2842 "\ This is to certify that policies of insurance listed below have been issued to the insured named above subject to the expiration date indicated be- low, 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. TYPE OF INSURANCE AND LIMITS Policy Effective Expiration COMMERCIAL GENERAL LIABILITY Number 49 649518 Date 10/01/94 Date 10/01/95 Limit Amount GENERAL AGGREGATE L1MIT(Other than Products-Completed Operations) $ 1, 000,000 PRODUCTS-COMPLETED OPERATIONS AGGREGATE LIMIT $ 1, 000,000 PERSONAL AND ADVERTISING INJURY LIMIT $ 500,000 .. EACHOCGURRENCELlMIT mu. ..... ............. ... .uu sm. . 500u;OOO . .. .uu. PHYSICAL DAMAGE LIMIT $ 50,000 ANY ON E LOSS MEDICAL EXPENSE LIMIT . $ 5,000 ANY ONE PERSON WORKERS' COMPENSATION & Policy Effective Expiration EMPLOYERS' LIABILITY Number Date Date Coverage Limits WORKERS' COMPENSATION STATUTORY - applies only in the following states: BODILY INJURY BY ACCIDENT $ EACH ACCIDENT EM PLOYERS' BODILY INJURY BY DISEASE $ EACH EMPLOYEE LIABILITY BODILY INJURY BY DISEASE $ POLICY LIMIT Policy Effective Expiration AUTOMOBILE LIABILITY Number 49649518 Date 10/01/94 Date 10/01195 Coverage Basis Limits ANY AUTO OWNED AUTOS HIRED AUTOS Combined Single Limits of Liability BODILY INJURY & PROPERTY DAMAGE~ 300,000 I EACH ACCIDENT SPECIFIED AUTOS x NON-OWNED AUTOS Split Liability Limits Bodily Injury Property Damage Each OWNED PRIVATE PASSENGER AUTOS $ PERSON OWNED AUTOS OTHER THAN PRIVATE PASSENGER $ $ ACCIDENT UMBRELLA LIABILITY Policy Number Effective Date Expiration Date EACH OCCURRENCE I GENERAL AGGREGATE I PRODUCTS-COMPLETED OPERATIONS AGGREGATE $ I $ I $ OTHER(Show Policy Effective ~~tion type of Policy) Number Date D r?r;:;.,~nnn~rr :'\ ---=",', ~'\ lS li!J lb lJ W ~ 1 I , j - ') I:'I:'D . ~ '^^P" DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/sPECIAL ITEMS ...- I 0 177J CANCELLATION Sf~~ ~ I{ - J~AGEMEN r '}. ,,; Number of days notice FRANK L MASSARO SR 09/30/94 Authorized Representative Date Should any of the above described policies be cancelled before the expiration date, the issuing company will endeavor to mail within the number of days entered above, written notice to the certificate holder named above, But failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives. U10523.2 Page 1 of 1 I II &4-6U-- RECEIVED FES 2 4 1995 CITY CLERK DE" YOU'RE IN GOOD HANDS WITH ALLSTATE@ · BUl14-2 ------------------- --- f.';: 11'1 b . 95 04: 2 4 PM P 1 A C VI +8 813 464 4608 I-H:< I Pas;le 2 I. ~ r- e L1..1.6 ':.:~z":.\.1.::1 ~ c:::"' lJ-._ ~ Anstafif CommercIal General LIability POLICY NUMBER: 49649518 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL 'NSURl:O - OWNERS, LESSEES OR CONTRACTORS (FORM 8) ThIs endorsen"1ent modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Per$on or OrganIzation: CITY OF CLEARWATER PLANNING & URBAN DEVELOPMENT PO BOX 4748 CLEARWATER FL 3461B.474a (If no entry appears sbove, Inform"llon required to complete this endors.ment will b. shown II' lhe Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section Ii) is amended to include as an Insured the person or organizatiot\ shown I n the Sched u Ie, but 0 n Iy with respect to liability arisi ng 0 ut of you r ongoing operations perfor med for that insured. CG2010 10 93 Copyrigl)t, Insurance Services Office. Inc., 1992 Page10f1 \ \ \ Allstate" I POLICY NUMBER: 49649518 colmercial General Liability THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, lESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: CITYOFCLEARWATERPLANNINGU& URBAN DEVELOPMENT PO BOX 4748 CLEARWATER FL 34618-4748 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. CG2010 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 II I BU114-2 YOU'RE IN GOOD HANDS WITH ALLSTATE@ Allstate" . . ) CERTIFICATE OF INSURANCE I ~ ALLSTATE INSURANCE COMPANY D ALLSTATE INDEMNITY COMPANY D ALLSTATE TEXAS LLOYDS 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. CERTIFICATE HOLDER NAMED INSURED Name and Address of Party to Whom this Certificate is Issued Name and Address of Insured CITY OF CLEARWATER PLANNING & PINELLAS COUNTY ARTS COUNCIL URBAN DEVELOPMENT 400 PIERCE BLVD PO BOX 4748 CLEARWATER FL 34616-5133 CLEARWATER FL 34618-4748 This is to certify that policies of insurance listed below have been issued to the insured named above subject to the expiration date indicated be- low, 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. TYPE OF INSURANCE AND LIMITS Policy Effective Expiration COMMERCIAL GENERAL LIABILITY Number 49 649518 Date 10/01/94 Date 10/01/95 Limit Amount GENERAL AGGREGATE L1MIT(Other than Products-Completed Operations) $ 1,000,000 PRODUCTS-COMPLETED OPERATIONS AGGREGATE LIMIT $ 1,000,000 PERSONAL AND ADVERTISING INJURY LIMIT $ 500,000 EACH OCCURRENCE LIMIT $ 500;UOO .. . PHYSICAL DAMAGE LIMIT $ 50,000 ANY ONE LOSS MEDICAL EXPENSE LIMIT $ 5,000 ANY ON E PERSON WORKERS' COMPENSATION & Policy Effective Expiration EMPLOYERS' LIABILITY Number Date Date Coverage Limits WORKERS' COMPENSATION STATUTORY - applies only in the following states: BODILY INJURY BY ACCIDENT $ EACH ACCIDENT EMPLOYERS' BODILY INJURY BY DISEASE $ EACH EMPLOYEE LIABILITY BODILY INJURY BY DISEASE $ POLICY LIMIT Policy Effective Expiration AUTOMOBILE LIABILITY Number 49 649518 Date 10/01/94 Date 10/01/95 Coverage Basis Limits ANY AUTO OWNED AUTOS HIRED AUTOS Combined Single Limits of Liability BODILY INJURY & PROPERTY DAMAGE~ 300,000 I EACH ACCIDENT SPECIFIED AUTOS X NON-OWNED AUTOS Split Liability Limits Bodily Injury Property Damage Each OWNED PRIVATE PASSENGER AUTOS $ PERSON OWNED AUTOS OTHER THAN PRIVATE PASSENGER $ $ ACCIDENT UMBRELLA LIABILITY Policy Number Effective Date Expiration Date EACH OCCURRENCE I GENERAL AGGREGATE I PRODUCTS-COMPLETED OPERATIONS AGGREGATE $ I $ I $ OTHER(Show Policy Effective Expiration -type-of.-folicy} ...... u. ..... . .._,--,.-,"-- . NlImb.er _ - Date - Date ~- . DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONSISPECIAL ITEMS CANCELLATION Number of days notice FRANK L MASSARO SR 08/11/94 Authorized Representative Date Should any of the above described policies be cancelled before the expiration date, the issuing company will endeavor to mail within the number of days entered above, written notice to the certificate holder named above. But failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives, U10523-2 Page 1 of 1 II I III BU114-2 YOU'RE IN GOOD HANDS WITH ALLSTATE@