CERTIFICATE OF LIABILITY INSURANCE (3)
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYVYY)
03/02/2005
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
BROWN & BROWN OF lV, INC, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
POBOX 25001 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
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 (Phila 18058
Religious Community Services Inc INSURER B:
503 S Martin King Jr. Ave INSURER C:
Clearwater, FL 33756 INSURER D:
INSURER E:
COVERAGES
Client#' 14895
RElCO
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATEO. 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.
'N:!iR I'WD TYPE OF INSURANCE POLICY NUMBER ~~';Jm8~E POLICY EXPI~~N LIMITS
LTR NSR
A ~NERAL LIABILITY PHPK111800 03/01/05 03/01/06 EACH OCCURRENCE $1 000000
rX- OMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $100000
- CLAIMS MADE [i] OCCUR MED EXP (Any ooe person) $5 000
- PERSONAl & AOV INJURY $1.000 000
GENERAL AGGREGATE $3.000 000
~'L AGGRnE LIMIT APnS PER: PRODUCTS - COM PlOP AGG $3.000 000
POLICY ~~8i LOC
A ~OMOBILE LIABILITY PHPK111800 03/01/05 03/01/06 COMBINED SINGLE LIMIT
~ ANY AUTO (Ea accident) $1,000,000
- AlL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
-
.!... HIRED AUTOS BODILY INJURY
$
~ NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident)
~RAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A ~ESSIUMBRELLA LIABIUTY PHUB042224 03/01105 03/01/06 EACH OCCURRENCE $1 000 000
X OCCUR 0 CLAIMS MADE AGGREGATE $1 000 000
$
~.IDEDUCTIBLE $
X RETENTION $10000 $
WORKERS COMPENSATION AND I we STATU- I 10J~-
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICERlMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
~reM~~v.~1o~s below E.L. DISEASE - POLICY LIMIT $
A OTHER Professional PHPK111800 03101105 03101/06 $1,000,000 Occurrence
Liability $3,000,000 Aggr~ Cr- J.:O
Vd .';e"'-
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHIClES I EXCLUSIONS ADOED BY ENDORSElENT I SPECIAl PROVISIONS
Evidence of Insurance during policy tenn.
Evidence of Coverage During Policy Tenn with Respect to Grant Grace
House Program.
CERTIFICATE HOLDER
CITY OF CLEARWATER
ATTN: MIKE HOLMES
PO BOX 4748
CLEARWATER, Fl 33758-4748
CANCElLATION
SHOULD MY OF THE ABOVE DESCRIBED POLICIES BE CANCEUJ:D BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOlDER NAMED TO THE LEFT. BUT FAILURE TO DO so SHALL
M>OSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
~
#M185830
ACORD 25 (2001/08) 1 of 2
DlF
e ACORD CORPORATION 1988