CERTIFICATE OF INSURANCE (4)
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
03/04/04
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
BROWN & BROWN OF LV, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
POBOX 25001 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Lehigh Valley, PA 18002-5001
800 634-8237 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: PHILADELPHIA INDEMNITY INS CO (PHIL AI 8058
RELIGIOUS COMMUNITY SERVICES INC INSURER B: INDIAN HARBOR INSURANCE
1855 HIGHLAND AVE S INSURER C:
CLEARWATER, FL 33756 INSURER D:
INSURER E:
Client#: 14895
RELCO
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 P&-{~1ri~~68tW1E p~~fl(~~~~N LIMITS
A GENERAL LIABILITY PHPK073966 03/01/04 03/01/05 EACH OCCURRENCE $1 000000
I-- ~~~~~H9E~Eo~~~R"nc"\
X COMMERCIAL GENERAL LIABILITY $100000
I CLAIMS MADE [Xl OCCUR MED EXP (Anyone person) $5.000
PERSONAL & ADV INJURY $1.000 000
I--
GENERAL AGGREGATE $3.000 000
I--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $3.000 000
n n PRO- nLOC
POLICY JECT
A AUTOMOBILE LIABILITY PHPK073966 03/01/04 03/01/05 COMBINED SINGLE LIMIT
I-- $1,000,000
X ANY AUTO (Ea accident)
I--
ALL OWNED AUTOS BODILY INJURY
I-- $
SCHEDULED AUTOS (Per person)
I--
,!... HIRED AUTOS BODILY INJURY
$
X NON-OWNED AUTOS (Per accident)
I--
I-- PROPERTY DAMAGE $
(Per accident)
RRAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A ~ESS/UMBRELLA LIABILITY PHUB027923 03/01104 03/01/05 EACH OCCURRENCE $1 000 000
X OCCUR D CLAIMS MADE AGGREGATE $1.000 000
$
8 DEDUCTIBLE $
.~- n. XRETENl'I0N' "',',' $40000 -- ------ 'n' "~~~~ "_' $
WORKERS COMPENSATION AND I T~~N~W~ I ~ 10J~'
EMPLOYERS' LIABILITY
ANY PROPRIETOR!PARTNER!EXECUTIVE E.L. EACH ACCIDENT $
OFFICER!MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $
A OTHER Professional PHPK073966 03/01/04 03/01/05 $1,000,000 Occurrence
Liability $3,000,000 Aggregate
B Propertv& Wind 2510224/2510218 03/01/04 03/01/05 Location Specific
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Evidence of Coverage During Policy Term with Respect to Grant Grace
House Program.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF CLEARWATER DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ---1.0.- DAYS WRITTEN
ATTN: MIKE HOLMES NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
PO BOX 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
CLEARWATER, FL 33758-4748 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
S..101A.h q,~ j
ACORD 25 (2001/08) 1 of 2 #S1511501M1
51143
MOC
€I ACORD CORPQpATIQtt 1988
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