CERTIFICATE OF LIABILITY INSURANCE (2)
C
:JJ.:JO~
HRH company of Tampa
5405 Cypress Center Dri~~
POBox 23968
Tampa, FL 33623
IN!lUIIIUI
Young Women's Christian
Association of Tampa Bay
655 Second Avenue South
St. Petersburg, FL 33701
COVERAGES
llATEIMM,gD/Y'I'I
12/10/0tJ..
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFEFlS NO flIGHTS UPa'f THE CERTIFICATE
IiOt..nER. THIS CERTIFICATE DOES NOT AMEND, EXTaAD ~
ALTER me COVERAGE AFFORDED BY' THE POLlaES BELOW.
INSURms AFFORDING COVERAGE
INsu~e~A; Royal Indemm.ty Insura,noe Company
INSURER El;progress1ve Express
INSURERc:General Star Indemnity/AON Risk S
INSURER D:FCCI Insurance Company
INSUFlER E:
'niE POUClESOFINSURANCE LISTEl BB.CW HAVE Be&N lSSU&D TO 'I1-iE lNSUFlEl) NIIMED N!DJE FOR'niEPOLJCYP~INDICA1ED. NOIWlTHSTANDING
ANY REQUIReMENT. TCFllIII OR CQIlDf110N Of PNY COlII11'IACT OR cm-tas Docunerr wmt fIeSP'EC't 10 WHICH THIS ceA'I'11=lCATe MAV BE Il!SJED OR
MAV PERTAIN, ntE INSURANC& AFFOAD&D BY TH1i PQ.1Cl&;S DIiSCRlBEl H&FlEIN IS SUB.EC'l' TO AlL ~E TERMS, El<Cl.U8ION8 AND CCII\IDrTlONS OF SUCH
POUCl&S. . AGGFlIiGI\11i LIMITS SloIcmN w,v loIAVl ~ R&DUC&D BY PAID ClAIMS.
r~~ ,-----_... "._~.__.m."'_ ~ Il'Qll!1{ EXPIFlA~~
TYPE OF INSURANCE POllCYNUMIlEA llMIT!l
A ~NEIIAllIAllllTt' RSP242236 ~OiOl/01 10/01/02 EACI'IOCCUFlFlENCE $1 . 000 . 000
X :5 Io1F.iRCIAI.G EN ERAI. liABILITY FIFlE DA MA(j 10 (Any one lire) $300.000
- OLAIMS MAIlF.;[j] OCCUR MED ElCP(AnYQlle person) $10 Jill..P
PEFlSONAl & ADV INJUFlY .1. 000 , 000
tiENERAl AGl;J FH:l;J ArE $3 o 0 Q.,_Q.P~
~'lAG;G;R,nE I.IMIT AP~-i PER: PRODUCTS .COMP/OPACllC3 $3.000.000
F'OI,II::V j~gi 1.00
B AUTOMoallE lIADlllTV 047436120 10/01/01 10/01/02 COMBINED SINClllE liMIT $1,000,000
-
X ANV AlJTO IEaaCclclenl)
..
All OWNED AUTOS ElODllYINJURY
- $
SCHEDULED AUTOS (f'er ~-)
X l-tII'lEDAUTOS BOOII.YINJURY
X (I'lIr om> dB' I) .
NOli! -OWNED AUTOS
~ - PROPERTY I)A MAG F 1$
lPArllCold."l
~AAqE LIAIlIL11Y ArJTOONI.Y. F.AACCIDENT $ -
ANY AUTO OTHER THAN E:A ACC .
AUfO ONLY; AC3C3 .
C EXCEllS lIADlllTV IUG352768C 10/01/01 10/01/02 EACH I;)CcrJAAeNCe .1.000,~
:::] OCCUR D ClAll\IISI\IIADE AG;G;FlI;GA TE $ll 000 f. 000
$
=;1 DEDUCTIBLE :II
X RETENTION $10000 $
D WOAKEFlS COMPENSATION AND 001WCOIA38629 06/24/01 06/24102 X hWCSTATU- I 10TH.
TORY! IMITS EFl
EMI>lOYF.!II!l' ~IAllILITt' ~~CH ACCIDENT $100.000
E.1.,OISI;ASE.EA EMPIDYEE s100.000
e,L. DISEASE-POLICY I.IMIT "1$500.000
A OTHER Professional R.ST348834 10/01101 10/01/02 $1,000,000 Occ.
Liabilty $3,000,000 Agg.
l)li$CFlII'T10N 0'= OPEAATIONS'lOCATIONSfVEHIClES/fXClUllIONB ADDED In" EN DOAS EM ENT/SPECIA l PACI\IIS,O'UI
The captioned certificate holder is named as lessor/additional named
insured.
CERTIFICATE HOLDER I I AOllITlONAlINIlIJAED; INllUIIEIIlETTEII: CANCB.LAnON
IHOULDANYOFTHEAIlOV6 giScRIElEDI'O~ICIEll DECANCEllEO aEFDRETHE EXPlRA1l0N
.; City of Clearwater- OATI!:THEABlF, THEI!lSUINl!: INSUIIER Will ENDIOAVOII 10 MAll.3..0....- DA'I'llWRITTEN
612 Franklin street NOTlCE1OTHE CERTIFlCATE HOlDERNAME01OfHEle:T. 8UTFAiLUFlE 10 DoeOSHALL
Clearwater, FL 33756-5414 IMP08ENO 011 LI$ATION 011 ~IADlll1VOF ANYKIND UPON THE INlIUREFI,ITS AGENTS 011
FIR Ell ENTA TlVES.
I nH~E5X::k
Aca:lD 25-S P/g7) 1 0 f 2
ff:S76174/M731B3
JFN g ACORD ca:lPOAATION 1988
SAcilI'All:
":.
IMPORTANT
If the cel1lf1cate I'lolder is an ADOmONAL INSURED, the poIlcy(les) must be endorsed. A statement
on this certificate does nO! CXII'lfer rlgh1s 10 the certificate holder n lieu ofSUc:h el"Idorsement(s),
If SUBROGATION IS WAIVED, subjed 10 the terms <WId conditions of the policy, certain policies mFl)'
require an endorsement A slaIement en tnis certificate does not confer rights to me cenlficate
holder in lieu rA SUch endorsement(s).
DISCLAIMER
1l1e Cel1lficate ~ InsuranCE1 on the reverse side of 1his form does not constitute a contract between
the issuing insurer(s) , auttlorlzed representative or procb:er, and the certificate holder, nor does it
affirmatively or negatively Kmend, extend or alter 1I'le coverage afforded by the policies Iistecllhereon,
ACOFID25.S(7/97l2 of 2 #S76174/M73183
-!
. Childhood Without Fear
. Generation of Hope
. Second Chances
. Hate-free Community
~'r
"YVVCA
of
Tampa Say
Mission
Statement
Established locally in 1919, the
YWCA is an autonomous
women's movement providing
leadership for social change.
We work to achieve peace,
justice, equality and dignity
for all. We provide services
that develop youth and
strengthen women and families
0)
Uf'll.I;ed'lN:a1J
YWCA of Tampa Bay
Administrative Office
655 Second Avenue South
St. Petersburg, FL 33701..4103
(727) 896-4629 · Fax (727) 821-3478
. FAX COVER SHEET
Date:
March 4, 2002 .
To:
Janet Skinner
Clearwater Police Dept.
Fax # 5" (.,:) - 4 3 ~~ &l
Sandra Lyth
Deputy Director
From:
Pages:
2 + cover
MESSAGE:
Janet
Here is the insurance policy for 612 Franklin Street.
t ')
Sandra ~ t't1P
If YCIU did not receive the entire fax. please contact "Sandra" at (727) 896&4629 Ext25