CERTIFICATE OF LIABILITY INSURANCEACORD,M CERTIFICATE OF LIABILITY INSURANCE 01/27/20
PRODUCER (727)797-5193 FAX (727)797-8605
Alley, Rehbaum & Capes Assurance, Inc.
2433 Gulf to Bay Blvd. 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.
P.O. Box 4620
Clearwater, FL 33758
INSURERS AFFORDING COVERAGE
NAIC #
INSURED Life Force Cultural Arts Academy, Inc. INSURER A: Burlington Insurance Co.
1606 N. Highland Ave INSURER B:
Clearwater, FL 33755 INSURER C:
INSURER D:
INSURER E:
flnvrDA/.`.CC
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.
INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY BINDER 14004TFR 01/11/2009 01/11/2010 EACH OCCURRENCE $ 1,000,00
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,00(
CLAIMS MADE M OCCUR MED EXP (Any one person) $ 1,00(
A PERSONAL & ADV INJURY $ 1,000,00(
GENERAL AGGREGATE $ 2,000,00(
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP OF AGG $ Include
X POLICY E a LOC
AUT OMOBILE LIABILITY
COMBINED SINGLE LIMIT
$
ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS
(Per person)
$
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS
(Per accident)
$
PROPERTY DAMAGE $
(Per a?ldent)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR FICLAIMS MADE _
??. __ ,__ . ..__ . ....... ... .. .. AGGREGATE $
DEDUCTIBLE
RETENTION $ $
WC STATU- 0TH-
WORKERS COMPENSATION AND II FEB
EMPLOYERS' LIABILITY 1
L1 t ` "
ANY PROPRIETORIPARTNER16XECUTIVE .
I E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? ---- -- E.L. DISEASE - EA EMPLOYE $
If yes, describe under C)
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
.+LOTIC!^ATL U i nc I'AWr•CI 1 AYIAAI
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
City of Clearwater AUTHORIZED REPRESENTATIVE
Si nature on file w com an
ACORD 25 (2001108) OACORD CORPORATION 1988