CERTIFICATE OF INSURANCE (233)
'\ (" .....'"J ,{
ACORDN
CERTIFICATE OF LIABILITY INSURANCE
OP ID D DATE (MM/DDIYYYY)
UPARC-1 03 10 04
THIS CERTIFICATE IS ISSUED AS A MATTER OFINFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLI:IES BELOW
PRODUCER
Bouchard-Starcrest
101 Starcrest Drive
POBox 6090
Clearwater FL 33758-6090
Phone:727-447-6481 Fax:727-449-1267
INSURERS AFFORDING COVERAGE
INSURED
INSURER A:
FIREMAN'S FUND INSURANCE CO
NAIC#
21873
UPARC Inc
1501 North Belcher Road
Clearwater FL33765~1302
INSURER B: AMERICAN INTL SPECIALTY LINES
INSURER C: BRIDGE FIELD CASUALTY INS CO
INSURER D:
INSURER E:
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 DATE (MM/DDITY) DATE MM/D~ LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
t-- 12/01/03 12/01/04 PREMISES (Ea occurence)
A X COMMERCIAL GENERAL LIABILITY MZG80807667 $ 1000000
I' CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 10000
PERSONAL & ADV INJURY $ 1000000
-
GENERAL AGGREGATE $ 3000000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COM~OPAGG $ 3000000
I n PRO- nLOC Emp Ben. 1000000
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- 12/01/03 12/01/04 (Ea accident) $ 1000000
A ..!.. ANY AUTO 860MZA80241293
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AUTOS -
- .. "
X HIRED AUTOS BODILY INJURY
- (Per accident) $
X NON-OWNED AUTOS 't
-
- , ,~ ,i PROPERTY DAMAGE $
.:,.:, .; (Per accident)
GARAGE LIABILITY t AUTO ONLY - EA ACCIDENT $
=1 ANY AUTO L ; EA ACC $
OTHER THAN
AUTO ONLY: $
- C__,',' . AGG
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 1000000
B I!J OCCUR o CLAIMS MADE 9745501 12/01/03 12/01/04 AGGREGATE $ 1000000
$
Fx=J DEDUCTIBLE $
X RETENTION $10000 $
WORKERS COMPENSATION AND X I T8~v" LIM'rf's I IOJ~-
C EMPLOYERS' LIABILITY 19603019 04/01/04 04/01/05 $ 1000000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1000000
If yes, describe under EL DISEASE - POLICY LIMIT $ 1000000
SPECIAL PROVISIONS below
OTHER
dd/asst
DESCRIPTION OF OPERA TlONS J LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT J SPECIAL PROVISIONS
kh/asst
CERTIFICATE HOLDER
CITY OF CLEARWATER
PARKS AND RECREATION DEPT
100 S MYRTLE AVE #C-110
CLEARWATER FL 33756-5520
CANCELLATION
XCITYOF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO
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
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHOR EP SENTA
@ACORD CORPORATION 1988
ACORD 25 (2001/08)