CERTIFICATE OF INSURANCE
:~~:..III~. .il~III~llqillijllll.~~~!~i~~~~!~!I~~~!~!!'!~~11!!L~:ZI:~
wallace...Welch &: Willingham Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
3810 J..6t:h Street North HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
P . O. Box 3302 0 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
St. Petersburg FL 33733 COMPANIES AFFORDING COVERAGE
Keith Gramling/Weyman Willingh
813 -522 -7777
INSURED
COMPANY
A
Riscorp Insurance Company
COMPANY
B
Scottsdale Insurance Company
Religious Community Services
1855 Highland Ave South
Clearwater FL 34616
COMPANY
C
Maryland Casualty
COMPANY
o
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION L1M ITS
LTR DATE (MM/DDIYYI DATE (MM/DDIYYI
GENERAL LIABILITY GENERAL AGGREGATE
B COMMERCIAL GENERAL LIABILITY To Be Determined 10/01/95 10/01/96 PRODUCTS. COMP/OP AGG
CLAIMS MADE [!] OCCUR PERSONAL & ADV INJURY
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE
FIRE DAMAGE (Anyone fire)
MED EXP (Anyone person)
AUTOMOBILE LIABILITY
Determined 10/01/95 10/01/96 COMBINED SINGLE LIMIT
X X ANY AUTO To Be
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person)
X HIRED AUTOS BODILY INJURY
X NON.OWNED AUTOS (Per eccidenll
PROPERTY DAMAGE
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT
AGGREGATE
EXCESS LIABILITY EACH OCCURRENCE
UMBRELLA FORM AGGREGATE
OTHER THAN UMBRELLA FORM
A WORKERS COMPENSATION AND X STATUTORY LIMITS
EMPLOYERS' LIABILITY
EACH ACCIDENT
THE PROPRIETOR/ INCL 1581-7 10/01/95 10/01/96 DISEASE. POLICY LIMIT
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL DISEASE - EACH EMPLOYEE
OTHER
1,000,000
1,000,000
1,000,000
1,000,000
50,000
Excluded
1,000,000
100,000
500,000
100,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
RE: 1125 Holt Avenue, Clearwater, Fl
Certificate Holder is Additional Insured with respects to General
Liability only.
CLEAR01
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY 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 LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENT
City of Clearwater
Attn: Risk Management Office
P.O. Box 4748
Clearwater FL 34618