CERTIFICATE OF LIABILITY INSURANCE (5)
ACORD. CERTIFICATE OF LIABILITY INSURANC~d8N~8 I DATE IMMIODIYY)
11/13/03
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Carlisle Fields & Company, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 7910 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater FL 33758-7910
Phone: 727-797-0441 Fax:727-725-3663 INSURERS AFFORDING COVERAGE
INSURED INSURER A: Zenith Insurance Company
INSURER B: Markel Insurance Company
Young Women's Christian Assn INSURER C: Progressive Commercial
Of Tampa BaI
655 Second venue South INSURER 0:
St. Petersburg FL 33701
I INSURER E:
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.
INSR TYPE OF INSURANCE POLICY NUMBER ~'rtlJ.wDNYi . PO~.fi~r~Pl~T~?N LIMITS
LTR DATE MMlDDIYY
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
I---
B COMMERCIAL GENERAL LIABILITY TBD 10/01/03 10/01/04 FIRE DAMAGE (Anyone fire) $ 100000
I CLAIMS MADE [!J OCCUR MED EXP (Anyone petSOI1) $ 5000
PERSONAL & ADV INJURY $ 1000000
f--
GENERAL AGGREGATE $3000000
f--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMPIOP AGG $3000000
~ POLICY n ~rg: n LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
I-- $ 1000000
C ANY AUTO 04743612-1 10/01/03 10/01/04 (Ea accident)
-
ALL OWNED AUTOS BODILY INJURY
I-- $
X SCHEDULED AUTOS (Per person)
-
HIRED AUTOS BODILY INJURY
- $
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DMfAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $ 1000000
B o OCCUR D CLAIMS MADE TBD 10/01/03 10/01/04 AGGREGATE $ 1000000
$
R DEDUCTIBLE $
RETENTION $ 10000 $
WORKERS COMPENSATION AND I TOR~ILiM'tiS I IU~~
A EMPLOYERS' LIABILITY Z049904501 06/24/03 06/24/04 E.L. EACH ACCIDENT $500,000
E.L. DISEASE. EA EMPLOYEE $500,000
E.L. DISEASE. POLICY LIMIT $500,000
OTHER
DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLES/EXCLUSlONS ADDED BY ENDORSEMENTISPECIAI.. PROVISIONS
*30 Days Cancellation applies to Worker's Compensation Policies, 10 Days
Cancellation for all other policies - Applies to Florida Employees Only.
CERTIFICATE HOLDER I N I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
CITYC-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL * DAYS WRITTEN
Howie Carroll Asst Dir of -
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHAlL
Housing IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
City of Clearwater City Hall
112 S. Osceola Avenue 1 FL REPRESENTATIVES.
Clearwater FL 33758-4748 ~"jJ (rh J ~ in
I
ACORD 25-S (7/97) v - V" . - (!t}At;ORD CO'RPORATION 1988