CERTIFICATE OF INSURANCE (5)
ACQ}lD....
14895
CERTIFICATE OF LIABILITY INSURANCE
Client
RELCO
I DEDUCTIBLE
-x1 RETENTION $10000
WORKI!RS COMPENSATION AND
EMPLOYERS' LIABILITY
IS
_____n'~'--m ___, .._, ___ _n___ -- ,--
is
1~~~r~1~;,,1 10Jt-1
E.L. EACH ACCIDENT S
E,L.DISEASE-EAEMPLOYEE S
E.L.DISEASE-POLICY LIMIT! S
$1,000,000 PER OCC.
$3,000,000 AGGREGATE
------ --- - '"
PRODUCER
BI<OWN & BROWN
POBOX 25001
LEHIGH VALLEY,
800 634-8237
OF LV,
INC.
DATE (MM/DDIVY)
03/04/02
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.
PA
18002-5001
INSURERS AFFORDING COVERAGE
INSURERA:CNA INSURANCE (SIEGEL)
INSURED
RELIGIOUS COMMUNITY SERVICES INC
1855 HIGHLAND AVE S
CLEARWATER, FL 33756
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOlWITHSTANDING
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.
II~~ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATlO
A ~NERALLIABILlTY HSF109588944 03/01/02 03/01/03
X COMMERCIAL GENERAL LIABILITY
I CLAIMS MADECK] OCCUR
LIMITS
-
-
~'LAGGRE~LIMIT~SPER:
I POLICY I I P'~gT I I LOC
A ~TOMOBILE LIABILITY
X ANY AUTO
f--- ALL OWNED AUTOS
f--- SCHEDULED AUTOS
.x HIRED AUTOS
.x NON-OWNED AUTOS
EACH OCCURRENCE $1 000 000
FIRE DAMAGE (Anyone fire s2 0 0 . 000
ME 0 EXP (Anyone person) ,s15 0 0 0
PERSONAL & ADV INJURY! sl 000 000
~_-_n_-----l---''..L------'--'-- ,,_,n,
GENERAL AGGREGATE I s3 I 000 I 000
PRODUCTS-COMP/OP AGG $3..L..QQ..QLQ.Q_9,_
HSF109588944
03/01/02 03/01/03
COMBINED SINGLE LIMIT
(Ea accident)
,
$1,000,000
BODIL Y INJURY
(per person)
$
BODILY INJURY
(per accident)
$
f---
PROPERTY DAMAGE S
(per accident) I
AUTO ONL y. EA ACpIDE-",,~ ~
RGARAGE LIABILITY
ANY AUTO
A ~CESSLIABILITY HSF109588944
...KJ OCCUR D CLAIMS MADE
03/01/02 03/01/03
EACH OCCURRENCE
EA_~CC .l!_____________
AGG s
$1 000 000
$1 000.000
S '
OTHER THAN
AUTO ONL Y:
AGGREGATE
103/01/02103/01/03
I I
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESlEXCLUSIONS AD DED BY ENDORseMENT/SPECIAL PROVISIONS
Evidence of Coverage During Policy Term with Respect to
House Program.
A OTHER PROFESSIONAL HSF109588944
LJIABILITY
CERTIFICATE HOLDER
I I ADDmONALlNSURED'INSURER LETTER:
Gte, ,,': 45:i~~'J:~:'~;'?'- L":~,,:;:''f;~':'i
~nrfr-L' ",' '!
! ~i
~ leit:) -- r," ,
r. ';"-~ii;\ :' o,."':,:/? i,l
L --.- l.-", 'i". !
unn~:'\,;"c ;_" i '; ,..,;
CANCELLATION CITY ('>cO; (', ",),"",::;,,~~;,'" ','':i~ i l
SHOULD ANY OFTHE ABOVE DESCRlBEDPOUCIESBECANCEUEO'BEFoREf'fH~noN
DATETHEREOF,THE ISSUING INSURER WILLENDEAVOR TO MAl L15 "'" DAYS WRITTEN
NDnCETOTHE CERTlFlCATE HOLDER NAMED TO THE ~, BUTFAlLURE TO DO so 5Hf'LL
IMPOSE NO OBLIGAnON OR L1ABIUTY OF ANY KIND UPON THE INSURER,ITSAGEN'1 OR
REPRESENTATIVES.
AUTHORIZED REPRESE~TATIVE
L)A /1r- -4A-~.....A
CITY OF CLEARWATER
ATTN: MIKE HOLMES
PO BOX 4748
CLEARWATER, FL 33758-4748
I
ACORD 25-S (7/97)1 of 2
#S81998/M81949
JMB (i) ACORD CORPORATION 1988
i
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.
ACORD25-S(7I97)2 of 2 #S81998/M81949