CERTIFICATE OF LIABILITY INSURANCE POLICY NUMBER O1CG1164931
. ACORDTM
CERTIFIC.~ TE OF LIABILITY INSURI" NeE
DATE (MMIDDIYVI
03/28/02
THIS CERTIFICAIE 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
ACORDIA EAST - TAMPA BAY
P,O. Box 31666
Tampa, FL 33631-3666
727-796-6666
INSURERS AFFORDING COVERAGE
INSURED
Clearwater Historical
Society
P.O.Box175
Clearwater FL 33757-0175
COVERAGES
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
AMERICAN STATES INS CO-09084
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,
.I~.f: TYPE OF INSURANCE POLICY NUMBER ':3.~Y EFFECTIVE POLICY EXPIRATION LIMITS
A ~ERAL LIABILITY 01CG1164931 1/20102 1/20/03 EACH OCCURRENCE $ 500000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ 200000
I CLAIMS MADE W OCCUR MED EXP (Anyone personl $ 10000
, PERSONAL & ADV INJURY $ 500000
-
GENERAL AGGREGATE $ 500000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS, COMP/OP AGG $ 500000
~ POLICY' n ~~R;. . n LOC
A AUTOMOBILE LIABILITY 01 CG1164931 1/20/02 1/20/03 COMBINED SINGLE LIMIT
- (Ea accldentl $ 500000
- ANY AUTO
- ALL OWNED AUTOS BODILY INJURY
{Per personl $
SCHEDULED AUTOS
-
c..X HIRED AUTOS BODILY INJURY
(Per accldentl $
c..X NON-OWNED AUTOS
,
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY ~I-' AUTO ONLY, EA ACCIDENT $
~ ANY AUTO .- '\?R <lp;'2
A .J'V OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
~ OCCUR 0 CLAIMS MADE _ ...-~~' r ,.
AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I T"t,i~TffI.~-..1 10l~'
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
E,L. DISEASE, EA EMPLOYEE $
E.L, DISEASE. POLICY LIMIT $
OTHER
IRECEIVED
DESCRIPTION OF OPERATIONS/LOCATIONSNEHIClESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
MAY 1 5 t002
RISK MANAGEMENT
CERTIFICATE HOLDER I X I ADDITIONAL INSURED: INSURER LEITER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRl8ED POLICIES BE CANCElLED BEFORE THE EXPIRATION
CITY OF CLEARWATER DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ---1Q.. DAYS WRITTEN
PARKS AND RECREATION DEPT NOTICE TO THE CERTIFICATE HOLDER NAMEO TO THE LEFT. BUT FAILURE TO DO SO SHALL
100 S MYRTLE AVE IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS .OR
"
CLEARWATER, FL 33756 REPRESENTATIVES,
1Tjrzj0ES!NTATIVE )}OfJ/1/
I II, ' / /1 /U J
ACORD 25-5 (7/97)
46- 42
@ACORD CORPORATION 1988
---0
"
_I
1-
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(iesl must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(sl.
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 endorsementls).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
tho issuing insurer(sl. 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 25-8 (7/97)