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CERTIFICATE OF LIABILITY INSURANCE (2)°08 OC T 1 Pm l:30 ACORD CERTIFICATE OF LIABILITY INSURANCE OPID S DATE(MM/DD/YYYY) PINE-13 09/30/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Brown & Brown Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 17757 US Highway 19 N, Ste 660 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 2456 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. rwater FL 33757-2456 e:727-461-6044 Fax: 727-442-7695 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Majestic Insurance Company 42269 INSURER B: Philadelphia Ind® ity Ins. Co 18058 Pinellas Opportunity Council Inc . INSURER C: 3443 1st Avenue North INSURER D: St Petersbur FL 33713 g 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE (MMfDDNY) DATE MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 B X X COMMERCIAL GENERAL LIABILITY PHPK349457 09/30/08 09/30/09 LTA AW" 'U 'I-NIED P REMISES EaOCCurence) $ 100000 ,-GLAIMS..M4D€-a OCCUR- - EIS F(V one Person) $ 5? 6 d PERSONAL & ADV INJURY $ 1000000 X Prof. Liab/Sex Abu GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $2000000 X POLICY PRO LOC JECT AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT E id $ 1000000 B ANY AUTO PHPK349457 09/30/08 09/30/09 ( a acc ent) ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIREDAUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ P ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR EICLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND ' X TORY LIMITS ER A EMPLOYERS LIABILITY , FRI ITIVF ? 5 PROM AJIFR/ X WCNC12270510801 09/30/08 09/30/09 E.L. EACH ACCIDENT $ 100000 _ ,_ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 100000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE- POLICY LIMIT $ 500000 OTHER B Crime Coverage PHPK349457 09/30/08 09/30/09 Crime 500000 - DED - -bb0 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate Holder is an additional insured as respects General Liability and only as regards the Named Insured NOV 2008 ter:` kFC?7RC34 sk"VICS, DEN CERTIFICATE HOLDER CANCELLATION City of Clearwater Community Development Block Grant Program 112 So Osceola Ave Clearwater FL 33756 ACORD 25 CITYOFC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 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. © ACORD CORPORATION 1988 OP ID S DATE (MM/DDIYYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE PINE-13 09/24/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Brown & Brown Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 17757 US Highway 19 N, Ste 660 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR .Box 2456 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. arwater FL 33757-2456 i ne:727-461-6044 Fax:727-442-7695 c INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Majestic Insurance Company 42269 INSURER B: Philadelphia Indemnity Ins. Co 18058 Pinellas Opportunity Council Inc. INSURER C: 3443 lst Avenue North FL 33713 St P t b INSURER D: ers urg e 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. IN5K LTR ADD' NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD/YY P LI Y E P I N DATE MMIDDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 B X X COMMERCIAL GENERAL LIABILITY PHPK349457 09/30/08 09/30/09 PREMISES(Eaoccurence) $ 100000 CLAIMS MADE IF-—] OCCUR - - .. - -- - - - - - - -- --, MEDEXP (Any one person) _ - - $ 5-0 0 0 _ PERSONAL BADVINJURY $ 1000000 X Prof. Liab/Sex Abu GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2000000 X POLICY PROECT LOC J AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT 1000000 B ANY AUTO PHPK349457 09/30/08 09/30/09 (Ea accident) $ ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GA RAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND X TORY LIMITS ER A EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/F XECIITIVE WCNC12270510801 09/30/08 09/30/09 E. L. EACH ACCIDENT $ 100000 _ .. - OFFICER/MEMBEREXCLUDED? -_- _ _----- - ---. -- -- _------ -. - -- - --- - _ _?__ --_ - _ ------_ - E.L. DISEASE - EA EMPLOYEE ---------.. _. $ 100000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE- POLICY LIMIT $ 500000 OTHER B Crime Coverage PHPK349457 09/30/08 09/30/09 Crime 500000 DED 5000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate Holder is an additional insured as respects General Liabilit?rr) +,',, 008 and only as regards the Named Insured CERTIFICATE HOLDER CANCELLATION CITYOFC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Community Development Block NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Grant Program 112 So Osceola Ave IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Clearwater FL 33756 REPRESENTATIVES. AUrIZED REJpR?EN T V 9 r ACORD 25 (2001/08) © ACORD CORPORATION 1988