CERTIFICATE OF LIABILITY INSURANCE (2)
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ACORQ,. CERTIFICATE OF LIABILITY INSURANCE DATE (MMlDDIYYYY)
11/10/2005
PRODUCER (727)461-3704 FAX (727)441-3298 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Lancaster Insurance Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1210 S. Myrtle Ave. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
POBox 2856
Clearwater, FL 33757 INSURERS AFFORDING COVERAGE NAIC#
INSURED Clearwater lawn Bowls Club INSURER A Southern-Owners Insurance
DBA: Carol Rawlings INSURER B:
1040 Calumet St INSURER c:
Clearwater, Fl 33755 INSURER 0:
INSURER E:
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 IADD' TYPE OF INSURANCE POlICY NUMBER POUCY EFFEC11VE POUCY EXPIRATION UMITS
GENERAL UABlUTY 20614827 04/20/2005 04/20/2006 EACH OCCURRENCE $ 500,000
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X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,()()(
I CLAIMS MADE 00 OCCUR MED EXP (Any one person) $ 5,()()(
A PERSONAl & ADV INJURY $ 500 , OO(
GENERAL AGGREGATE $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COM~OPAGG $ 500,000
I .nPRO- n
POLlCYJECT LOC
AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT
- (Ea accident) $
ANY AUTO
-
ALL OWNED AUTOS BODILY INJURY
I-- (Per person) $
SCHEDULED AUTOS
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HIRED AUTOS BODILY INJURY
I-- (Per accident) $
NON-OWNED AUTOS
I--
'-- PROPERTY DAMAGE $
(Per accident)
GARAGE UABIUTY AUTO ONLY - EA ACCIDENT $
==i ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSlUMBRELLA UABlUTY EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND IlX~:i~W~ I IO~-
EMPLOYERS' LIABIUTY E:L EACH ACCIDENT $
ANY PROPRIETOR/PARTNERlEXECUTNE
OFFICER/MEMBER EXCLUDED? E:L DISEASE - EA EMPLOYEE $
If yes, describe under E:L DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
I\dditional Insured: City of Clearwater, Parks & Recreation Department
C
TION
City of Clearwater
Parks & Recreation Department
Attn: Kyle
POBox 4748
Clearwater, Fl 33758
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 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR UABILlTY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
A (HORlZED REP~~SE""TIVE f) ~~
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@ACORD CORPORATION 1988
ACORD 25 (2001/08) FAX: 562-4825