CERTIFICATE OF LIABILITY INSURANCE (17)AdORD CERTIFICATE OF LIABILITY INSURANCE OP ID SH DATE(MMIDD/YYYY)
08
HEADS-2 12/19/
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
PRODUCER
Brown & Brown Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
17757 US Highway 19 N, Ste 660 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
2456
B
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P ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
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Clearwater FL 33757-2456
Phone: 727-461-6044 Fax:727-442-7695 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Ace American Insurance Co 22667
INSURER B: Zenith Insurance Company 13269
Head Start Child Development
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INSURER C:
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2210 Tall Pines Dr. Ste 200 INSURER D:
Largo FL 33771.
INSURER E:
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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.
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LTR
NSR
TYPE OF INSURANCE POLICY NUMBER POLICY E TIVE
DATE MMIDD POLICY EXPIRATION
DATE MM/DD/YY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1000000
A X X COMMERCIAL GENERAL LIABILITY G20400869 01/01/09 01/01/10 PREMISES (Eaoccurence) $ 100000
CLAIMS MADE X] OCCUR MED EXP (Any one person) $ 5000
PERSONAL & ADV INJURY $ 1000000
X Prof/Sex Abuse AGGREGATE
GENERAL $ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER: -
PRODUCTS - COMP/OP AGG $ 2 0 0 0 0 0 0
X POLICY PRO LOC
JECT Em Ben. 100/300
AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ 500000
A X ANY AUTO H08123032 01/01/09 01/01/10 (Ea accident)
ALL OWNED AUTOS BODILY INJURY $
SCHEDULED AUTOS (Per person)
HIREDAUTOS BODILY INJURY $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
H AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR El CLAIMS MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X TORY LIMITS ER
B EMPLOYERS' LIABILITY 2070082701 01/01/09 01/01/10 E.L. EACH ACCIDENT $ 100000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
E.L. DISEASE - EA EMPLOYEE
$ 10 0 0 0 0
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
$ 5 0 0 0 0 0
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate holder is an additional insured for general liability only with
regard to Sanderlin Center Playground - 918 Palmetto Street, Clearwater, FL
I.COTI CIf? AT0 Uf"%i r1CC CA NI.FLLA I ILI N
CITYOFC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
City of Clearwater NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
ATTN Earl Barrett IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O. Box 4748
FL 33758-4748
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