CERTIFICATE OF LIABILITY INSURANCE (66)ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DATE(MM/DD/Y
11 14 0 08
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PINFIL-1
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Kirby & Associates
John L HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
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s ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
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4196 Her
Jacksonville FL 32210-2260
Phone:904-387-9798 Fax:904-387-9270 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Arch Insurance Company
INSURER B:
Big Brothers Big Sisters of INSURER C:
-
Pinellas County, Inc.
918 west Bay Drive INSURER D:
Largo FL 33770
INSURER E:
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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 __W
DATE MM/DD/YY
DATE MM/DD/YY
PO
LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
X X COMMERCIAL GENERAL LIABILITY NCPKG0006100 11/19/07 11/19/08 PREMISES (Eaoccurence) $ 100,000
A MADE X? OCCUR
CLAIM MED EXP (Any one person) $ 5 , 0 0 0
S PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE s2,000,000
IL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000
POLICY PRO LOC
JECT
It
AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident) $ 1,000,000
ANY AUTO (
ALL OWNED AUTOS BODILY INJURY
erson)
Pe $
SCHEDULED AUTOS (
r p
A X HIRED AUTOS NCPKG0006100 11/19/07 11/19/08 BODILY INJURY
accident)
P $
X OWNED AUTOS
NON (
er
- PROPERTY DAMAGE
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P $
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)
(
er acc
GARAGE LIABILITY -- AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
I! AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR ? CLAIMS MADE L
-- AGGREGATE
$
DEDUCTIBLE $
RETENTION $ ?- . _......_ _---- - ?.-. .--. $
WORKERS COMPENSATION AND TORY LIMITS ER
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXECUTIVE
If yes, describe under
SPECIAL PROVISIONS below E L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Additional Insured: City of Clearwater for use of facilities for Frenchy's
16th Annual Gumbo Tennis Classic Rvent on November 14-16, 2008.
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 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
City of Clearwater
REPRESENTATIVES.
112 S. Osceola Avenue
Clearwater FL 33756 AUTHORIZED REPRES T
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John L. Kir
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ACORD 26 (2001108)