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CERTIFICATE OF LIABILITY INSURANCE (6) ACORD... CERTIFICATE OF LIABILITY INSURANCE OP ID DATE (MMlDD/YYYY) YOUNG-8 06 15 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 Carlisle Fields &. Company, Inc P,O, Box 7910 Clearwater FL 33758-7910 Phone:727-797-0441 Fax:727-72S-3663 INSURED INSURERS AFFORDING COVERAGE Young Women's Christian ABsn Of Tampa Bay 655 Second Avenue South St, Petersburg FL 33701 COVERAGES INSURER A: INSURER B: INSURER C: INSURER 0: INSURER E: Zenith Insurance Markel Insurance Com an: Pro essive Commercial NAlC# 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 CONlRACT 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 CONornONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR NSR[ TYPE OF INSURANCE POLICY NUMBER ~~~MMID DATE MMlDDIYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 t---- I PREMiSes (Ea occurence) B COMMERCIAL GENERAL LIABILITY 3602SS258399 10/01/03 10/01/04 $ 100000 I CLAIMS MADE [!]. OCCUR MED EXP (Anyone person) $ 5000 PERSONAl & ADV INJURY $ 1000000 GENERAl AGGREGATE $ 3000000 ~'L AGGREGATE LIMIT APPLIES PER: PRODUCTS.COMP~PAGG $ 3000000 ,nPRO. n POLICY JECT LOC ~OMOBlLE LIABILITY COMBINED SINGLE LIMIT $1000000 C ANY AUTO 04743612-1 10/01/03 10/01/04 (Ea accfdent) I-- ALL OWNED AUTOS BODILY INJURY r-- $ ~ SCHEDULED AUTOS (Per person) - HIRED AUTOS BODILY INJURY $ NON.QWNED AUTOS (Per accfdent) - - PROPERTY DAMAGE $ (Per accfdent) GARAGE lIABILITY AUTO ONLY. EA ACCIDENT $ R ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELlA lIABILITY EACH OCCURRENCE $1000000 B =:J OCCUR o ClAIMS MADE 4602SS258161 10/01/03 10/01/04 AGGREGATE $ 1000000 $ ==i. DEDUCTIBLE $ RETENTION $10000 $ WORKERS COMPENSATION AND I TORY LIMITS I IVE~. A EMPLOYERS' LIABILITY Z049904501 06/24/04 06/24/05 $ 500,000 ANY PROPRIETORlPARTNERlEXECUTIVE E.l. EACH ACCIDENT OFFICERlMEMBER EXCLUDED? E,L DISEASE. EA EMPLOYEE $ 500,000 ~s, describe under $500,000 ECIAL PROVISIONS below E.L DISEASE. POLICY LIMIT OTHER DescRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS *30 Days Cancellation applies to Worker's Compensation Policies, 10 Days Cancellation for all other policies - Applies to Florida Employees Only, '04 JUN 21 PM"! ~?Q CERTIFICATE HOLDER City of Clearwater Risk Mgt Pat Fernandez PO BOX 4748 Clearwater FL 33758 CANCELLATION CInO 0 5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIRCATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR lIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REP PORATION 1988 lCORD 25 (2001/08) ACORDN CERTIFICATE OF LIABILITY INSURANCE OP ID DATE (MMlDDIYYYY) YOUNG-8 06 15 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 Carlisle Fields & Company, Inc P,O, Box 7910 Clearwater FL 33758-7910 Phone:727-797-0441 Fax:727-725-3663 INSURED INSURERS AFFORDING COVERAGE INSURER A: Zenith Insurance Company INSURER B: Markel Insurance Company INSURERC: Progressive Commercial INSURER D: INSURER E: NArc # Young Women's Christian Assn Of Tampa Bay 655 Second Avenue South St, Petersburg FL 33701 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 MAYBE 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, NSR[ POLICY NUMBER "di1'~iMM1ODIYYI ~b'ID-}!XN LIMITS LTR TYPE OF INSURANCE DATE (MMlDD GENERAL LIABILITY EACH OCCURRENCE $ 1000000 I-- B COMMERCIAL GENERAL LIABILITY 3602SS258399 10/01/03 10/01/04 PREMISES (Ea occurence) $100000 I CLAIMS MADE [!J OCCUR MED EXP (Anyone person) $ 5000 .- ----- -,- --- . --- " -'- ."- -- - .- "-.,"- - -,."- --. $ 1000000 -1"----- --- . -- PERSONAL & ADV INJURY GENERAL AGGREGATE $ 3000000 - GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG $3000000 I nPRO. n POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1000000 - C ANY AUTO 04743612-1 10/01/03 10/01/04 (Ea accident) - I-- ALL OWNED AUTOS BODILY INJURY $ r-!- SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY I-- $ NON.OWNED AUTOS (Per accident) - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $ ==l ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1000000 B ~ OCCUR o CLAIMS MADE 4602SS258161 10/01/03 10/01/04 AGGREGATE $ 1000000 $ =l DEDUCTIBLE $ RETENTION $10000 $ WORKERS COMPENSATION AND I TORY LIMITS I IUEit A EMPLOYERS' LIABILITY Z049904501 ~~l~4LO~__ Q.6j2.~ 10-.s $ 500,0.00 ANY PROPRIETORlPARTNERlEXECUTIVE E.L EACH ACCIDENT -- ,-. -- OFI'ICERlMEMBEREXCLlJDEDT -"--- .. -----'---- -,---, -_.-- .- "--. -' -- - - -- EL DISEASE. EA EMPLOYEE $ 500,000 ~~~Mts~~~V~~?gNS below E,L DISEASE. POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS *30 Days Cancellation applies to Worker's Compensation Policies, 10 Days Cancellation for all other policies - Applies to Florida Employees Only, CERTIFICATE HOLDER CANCELLATION Sid Klein Chief 0 fPolice Clearwater Police Dept 645 Pierce Street Clearwater FL 33756-5414 SIDNE -1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPR PORATION 1988 ACORD 25 (2001/08) ACORD", CERTIFICATE OF LIABILITY INSURANCE PRODUCER Carlisle Fields & Company, Inc P,O, Box 7910 Clearwater FL 33758-7910 Phone:727-797-0441 Fax:727-725-3663 INSURED Young Women's Christian Assn Of Tampa Bay 655 Second Avenue South St, Petersburg FL 33701 COVEMGES OP ID DATE (MMlDDIYYYY) YOUNG-8 06 15 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. INSURERS AFFORDING COVERAGE NAIC# INSURER A: INSURER B: INSURER C: INSURER D: INSURER E: Zenith Insurance Company Markel Insurance Company Progressive Commercial 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 MAYBE 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, LTR NSR[ TYPE OF INSURANCE POLICY NUMBER DATE (MMlDDIYYI DATE~ LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 I--- B COMMERCIAL GENERAL lIABILITY 3602SS258399 10/01/03 10/01/04 '::'~MI'\\":: $100000 >-- I CLAIMS MADE [!J OCCUR PREMISES (Ea occurence) MED EXP (Anyone person) $ 5000 _ .- "-- -_-._---. -,-- -.'-_'__ ,___ ______n__'_ -.----- --- ---_._-,- ---.-- " ---..- ---- -PERSONAL & ADV-INJURV . f-sIouOlHn) -- --.--- - GENERAL AGGREGATE $ 3000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG $3000000 I .nPRO. n POLICY JECT lOG AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 - C ANY AUTO 04743612-1 10/01/03 10/01/04 (Ea accident) - - All OWNED AUTOS BODilY INJURY $ ~ SCHEDULED AUTOS (Per person) HIRED AUTOS BODilY INJURY >-- $ NON.OWNED AUTOS (Per acddent) I--- PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $ ==j ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 1000000 B =:J OCCUR o CLAIMS MADE 4602SS258161 10/01/03 10/01/04 AGGREGATE $ 1000000 $ =l DEDUCTIBLE $ RETENTION SlOOOO $ WORKERS COMPENSATION AND I TORY LIMITS I IOJ~. A EMPLOYERS' LIABILITY Z049904501 _Jl6/21/()4. Q~L2419? E}"EACH ACCIQENT .$ 500,000 ANY PROPRIETORlPARTNERiEXI;CJ.ITlVE_c_ - -- ----,-- - --- - - .... --- OFFICERlMEIVlBEItEXCLUDED'I E.L DISEASE. EA EMPLOYEE $ 500, 000 ~~~Mf~~~v'ts?<fNs below E,L DISEASE. POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate Holder is listed as an additional insured, *30 Days Cancellation applies to Worker's Compensation Policies, 10 Days Cancellation for all other policies - Applies to Florida Employees Only, CERTIFICATE HOLDER CANCELLATION CLEARW6 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIACATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPR Clearwater Police Department Chief Of Police Sid KHen 645 Pierce Street Clearwater FL ACORD 25 (2001/08) PORATION 1988