CERTIFICATE OF LIABILITY INSURANCE (3)
Client
51582
3YOUNWOM
- ACnRDT~
CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YY)
11/14/02
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
HRH Company of Tampa
5405 ~ypress Center Drive
POBox 23968
Tampa, FL 33623 I INSURERS AFFORDING COVERAGE
INsuRED-----~~---------:- , ~-------~----~--l~-~~~R A: RoyaTlndemni t y I!1~_~:t"' an<:_~_CompailY=
i~~~~i:~~~~ ~f C~~~~~l:~y I-~;~~~:~~:~~~~~~~~~~~~~~~~-c~~g-~~y-
655 Second Avenue South ~ ----------------------~-----
INSURER D:FCCI Insurance Company
St. Petersburg 1 FL 33 701 INSU~ERE:Hartfo~-------- ----------------------...
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED_ NOlWfTHSTANDING
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.
1NSRr POLlfJI~FFECTJ~IPOLlCY ~XPIRATI9~ -----..-------.-..---....----..-..-..-- - --- -----.-.-.-----
LTR TYPE OF INSURANCE POLICY NUMBER OAT MM/DD/ DATE MM/DD/Y LIMITS
A I GENERAL LIABILITY !R2SP243591 10/01/02 !10/01/03 EACH OCCURRENCE 1$1 000 000
___.___._.___,___.~_.___,_...___,._____:..____,___J_.________1__
I~M'"c~G"OR~'."urr I FIRE DAMAGE (Any one fireL~Q_9_LQJl.Q_
I CLAIMS MADE[X] OCCUR! MED EXP(Any one person)~~_lQJ.Q.Q.Q___
1-----.- ..---...
I PERSONAL & ADV INJURY ~O 0 0 ,~Qj)__
1- GENERAL AGGREGATE 1$3 000 000
-----------_._--_.__._----_._----~---'---~-
~(3EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s1.LQQQ.LQQQ__
-l POLICY n ~~gr Ii LOC 1 i
B 047436120 '10/01/02 ;10/01/03 ,
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT i $1 000 000
-Xl ANY AUTO (Ea accident) 1"
-----------.--,._- -" --....,..-."------
~ ALL OWNED AUTOS BODIL Y INJURY is
'-'-- SCHEDULED AUTOS (Per person)
1""--"'--\ --~---------------- - -.-------
I X I HIRED AUTOS BODIL Y INJURY
1-, ,$
. ~j NON-OWNED AUTOS (Per accident)
i ,
PROPERTY DAMAGE :$
I (Per accident)
I
GARAGE LIABILITY AUTO ONLY- EAACCIDENTI $
-=1 ANY AUTO -- --..------..-.-.----
I OTHER THAN EA ACC : $
--"--,,,,,.. .. i--
AUTO ONL Y: AGG 1 $
C ' EXCESS LIABILITY !IUG352768D 10/01/02 110/01/03 EACH OCCURRENCE . .I~J La OQ.I....Q...Q.9.....
[] OCCUR D CLAIMS MADEl ! ~C>...G...R_E(3!\:rE:_________~ 00 0 ~ 0 0_
I i-----..---- - --------~-----------
i ...--.-.-..---
,--,
1:1 DEDUCTIBLE I ._-..-,. 1$
X RETENTION $10000 1$
D WORKERS COMPENSATION ANG - .. o 01WGOIA3 86 29-.. .-106- /24/02 06/2-4/03 ... ..-IT"6~~~tl&S:L~j~lg'I_.:......___~___
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT i $100 , 000
________m__....___ . ..._._...__
I E.L.DISEASE-EAEMPLOYE~J;LQQLQ. 00__
E.L. DISEASE-POLlCYLIMI $500, 000
A : OTHER Professional !R2ST419372 110/01/02.10/01/03 $1,000,000/$3,000,000
E Directors & Offi INOAOO04376 110/01/02110/01/03 I $2,000,000
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONSADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Additional Insured
CERTIFICATE HOLDER I I ADDmONALlNSURED; INSURER LETTER: CANCELLATION
SHOULD ANY OFTl-iE ABOVE DESCRIBE 0 POLICIES BE CANCELLED BEFORE THE EXPIRATION
Sid Klein, Chief of Police DATETHEREOF,THE ISSUING INSURER WI LL ENDEAVOR TO MAIL3.o___ DAYS WRITTEN
Clearwater Policy Dept. NonCE TOTl-iE CERTIFICATE HOLDER NAMED TO THE LEFT, BUTFAILURE TO DO SO SHALL
645 Pierce Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITSAGENTS OR
Clearwater , FL REPRESENTATIVES.
AUTHORIZED REPREjENTAT+
I D 'Z .:S. -~ ~
v
ACORD 25-S (7/97)1 of 2
#S91039/M91001
DJM @ 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)2 of 2 #891039 /M91001