CERTIFICATE OF INSURANCE (2)
APR-07-04
10: 15
FROM-Accricla Bi II Allen
727-799-5191
T~B59 p,OnZ/003 F-BSO
J'oI ,",vnu... l;1:1i 11r-Il;A II: OF LIABILITY INSURANCE I DATE IMM/DD/VYI
04/07/04
PROOUCaI THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ACORDIA EAST - TAMPA BAY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 31666 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTE;ND OR
Tampa, FL 33631-3666 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOw.
727.796-6666 INSURERS AFFORDING COVERAGE
INSURED Clearwater Historical 'NSURSA A: AMERICAN STATES INS CO-09084
Society INSUREA il:
P. O. Box 175 INSURER c,
Clearwater FL 33757-0175 INSURER D:
J INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUReD NAMED A.BOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANYREQUIREMSNi, TERM OF! CONDmON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDEO BY THE POLICIES DESCRIBeo HI!REIN IS SUBJECT TO ALL THE TeRMS, EXCLUSIONS AND CONDITIONS OF SUCI1
POLICies. AGGREGATe LIMITS SHOWN MAY HAVE BEEN l'IiDUCED BY PAID CLAIMS.
iN.f: TYPE OF INSURANCE POLICY NUMBER POLICY goFI1CTIVE POlicy EXPIRATION
A ~eftAl LIABILITY 01 CG 1184933 1/20/04
X COMMJ;RCIAL GENERAL LIAllIU'tY
J CLAIMS MADE W oCCUR
LIMITS
1/20/05
ffACH OCCURRENCE;
$
500000
200000
10000
5000~
500000
500000
FIRE DAMAGE (/IllY ol1e lI,e)
- -
- ~
I~'L AGGRE~ LIMIT AP~. PER:
L I POucy I.. I~~~ I I LOC
A ~TOMOBllE LIABILIlY
ANY AuTo
MEo EXP (Anv .na peraon,
$
PERSONAL & AOV INJuFlY
GENERAL AGGFlEGA TE
e
PRODUCTS - COMP/OP AGG e
01CG1164933
1/20/04
1/20/05
COIlilIOINEO SINGLe LIMIT ~
(E. acclllentl
BODILY INJURY ~
(Pnr peraonl
BODilY INJUf\Y B
IPar OQddnnn
PROPERTY DAMAGE ~
IPar ."clllent)
500000
-
~
I"-
~
rX
ALL OWfII.D AUTOS
SCHEOULEO AUTOS
HIRED AUTOS
NoN-oWNJ;O A\JTOS
GARAGE LtABILIlY
R- ANY AIJTO
EXCess LIABILITY
i=J OCCUR 0 I;LAIMS I\i1ADE
R OEDUCTIBLE
RETENTION e
WORK ells COMPENSATION AND
EMPLOYEFlS' LIABILITY
AuTO ONLY. EA ACCIDENT ,
oTH~R THAN
AUTO ONLY:
EA ,",CC ~
AGG &
eACH OCCURRENCE
AGGREGATE
t
$
e
e
t
OTHER
Hb~iI~Ws I IOlAM-
E.L. EACH ACCIDENT $
E.L DISEASE- EA EMPLOYEE ~
E.L. DISeASE - POLICy LIMIT ~
DESCRIPTION OF OPERATIONS/LOCATIOIIISNEHIC~eS/E)l;CLUSIONS AllO~D BY ENDORSEM~NT/SPECIAL PROVIsIONS
CERTIFICAiE HOLDER IS NAMED AS AND ADDITIONAL INSURED WITH RESPECTS
TO GENERAL I.IABILlTY.
CERTIFICATE HOLDER I X , AoDITIONAlINSUfl.D; INSURER lETTEfl:
CANCELLATION
CITY OF CLEARWATER
PARKS AND RECREATION DEPT
100 S MYRTLE AVE
CLEARWATER, FL 33756
I
ACORD 25-$ 17/971
46- 40
sHOULD ANY OF THE ABOV~ OesCRIBED POLICIes ilE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF. THE ISSUING IN5URER WILL !;IIlDEAVOR TO MAil -1Q.. DAYS WRITTEN
NOTlC!; TO THE CERTJ~ICA"E HOLDER NAI1/lI;tl TO THE lEFT. OUT FAlllJRE TO DO SO SHALL
IMPOSE NO OQLIGATlON 011 L1ABILIlY OF ANY 1(11110 UPON THE INSURER. ITS AGENTS OR
REPREseI\l'f4TIVES. I
AUTHORrDfRaj~NTATIV~ 'tJ/"}A..fA.- LI
.1 - ~ 'd ~-, /[,(
u
@ACORJ) CORPORATION 1988
APR-07-04
10: 15
F ROM-Ac 0 r i cla Bill A II en
727-799-5191
T~859 P.003/003 F-860
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policvlies) must be endorsed. A statement
on this certificate doss 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 Certifil:ate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer/sl. authorized representative or producer, and the certificate holder, nor does it
affirmatively or negativelv amend, extend or alter the coverage afforded by the policies listed thereon_
ACORD 25-5 /7/97)