CERTIFICATE OF INSURANCE (3)
ACORfL,
Client#: 14895
RELCO
CERTIFICATE OF LIABILITY INSURANCE
PRODUCER
BROWN & BROWN OF LV, INC.
POBOX 25001
LEHIGH VALLEY, PA 18002-5001
800 634-8237
DATE (MM/DD/YY)
04/25/03
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
----
INSURED
INSURERS AFFORDING COVERAGE
RELIGIOUS COMMUNITY SERVICES INC
1855 HIGHLAND AVE S
CLEARWATER, FL 33756
-, -
INsuRERA:TRANSCONTINENTAL (IRWIN SI~GEL)
[INSURER B:
i INSURER C:
,--
: INSURER 0:
,----
I INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOlWlTHSTANDING
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,
I~~~i I PgLlCY EFFECTIVE !POLlCY EXPIRATIONI -- ,---
TYPE OF INSURANCE POLICY NUMBER LIMITS
A GENERAL LIABILITY HSF109588944 03/01/03 03/01/04 I EACH OCCURRENCE T $1,000,000
-----, 1---."
~O""'RC",- .","" '''''IT> fl!'lE DAMAGE (Any ane fire $200,000
L _J CLAIMS MADEW OCC~R -- -- - --.- ---- -- --- -,'- ,MED EXf'{Anyane person) $15.000
-..
I -," '" " - PERSONAL & ADV INJURY $1.000 000
I
-- , -_0'
j GENERAL AGGREGATE $3 000 000
-- I
GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMP/OP AGG $3,000,000
Ii POLICY i-i ~~gT i-~l LOC I
A ~~TOMOBILE LIABILITY HSF109588944 103/01/03 03/01/04 COMBINED SINGLE LIMIT
lL ANY AUTO I (Ea accident) $1,000,000
~ ALL OWNED AUTOS BODIL Y INJURY
(Per person) $
--- SCHEDULED AUTOS
lL HIRED AUTOS BODIL Y INJURY
1<_ (Per accident) $
NON-OWNED AUTOS -----
~ PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY _~_T:OONLY- EAACCIDENT $
'=l ANY AUTO OTHER THAN EA ACC $ ...
AUTO ONLY: AGG $
A HSF109588944 j 03/01/03 03/01/04 I $1.000,000
EXCESS LIABILITY ~,OCCURRENCE
~XJ OCCUR [J CLAIMS MADE AGGREGATE $1,000.000
---- --
h I ---.- $
I---.j DEDUCTIBLE -- $
i X I RETENTION $1 0000 $
r WORKERS COMPENSATION AN 0 1,V;g~m1X-~ I TOJii-
~o
EMPLOYERS' LIABILITY E,L; EP,oH i\CCfOEm" 1-$- ---,
'------'.-- -- - -- ._----'---~- '.'. .....;-- -.- -~ --~ -. ._-~- -- - --- .. --- ~-- -,- -
E,L. D ISEASE-EA EMPLOY~ELt
, , 'E,L. DISEASE-POLICY L1MI~ $
A OTHER Professional HSF109588944 : 03/01/03 03/01104 $1,000,000 Occurrence
Liability $3,000,000 Aggregate
,
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
''''',,<h''''',
'lJ.:.i:":.il:,,::
CERTIFICATE HOLDER I I ADDmONALINSURED:INSURERLETTER: -- CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF CLEARWATER DATETHEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAl LtD.....-, DAYS WRITTEN
ATTN: MICHAEL HOLMES NOTlCETOTHE CERTIFICATE HOLDER NAMED TO THE LEFT, BUTFAILURE TO DO so SHALL
112 S OSCEOLA AVENUE IMPOSE NO OB LIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
CLEARWATER, FL 33756 REPRFl':FNTATIVES.
I ~~RIZ~D REP~RESEN~, .
--..-/lI'U--<-..-cA.... <A..L--(/)
~
ACORD 25- S (7/97)1 of 2
#S117558/M113714
PJT
@ ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does 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 Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon,
ACORD2S-S(7/97)2 of 2 #Sl17558/Ml13714
,-
CITY OF CLEARWATER
Interdepartmental Correspondence
f
TO:
FROM:
COPIES:
SUBJECT: See Below for Action Required - Contract Item - Reminder
_.llllllIl....IJ~.il,'-
Susan Stephenson, Document & Records Supervisor
DATE:
02/13/2003
This is a reminder that the item requiring action indicated below
has not yet been resolved. If the pending item has not been
received and the matter resolved, and the City Clerk Department
notified by 02/27/2003 a final notice will be sent. If you have
is not necessary to respond at this time unless there is a change
in status.
Item requiring action: INSURANCE EXPIRATION.
Party: RELIGIOUS COMMUNITY SERVICES
1125 HOLT AVE
Due: 03/01/2003
File No: 10-013-01
Date:
_/_/-
Action taken:
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Has item been paid or finalized?
YES
NO
NEW Expiration/Action date:
_/_/-
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