CERTIFICATE OF INSURANCE (247)
ACORD.
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CERTIFICATE OF LIABILITY INSURANCE
OP 10 D DATE (MM/DDIYYYY)
UFARC-l 02/03/05
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
Bouchard-Starcrest
101 Starcrest Drive
POBox 6090
Clearwater FL 33758-6090
Fhone:727-447-6481 Fax: 727-449-1267
INSURED
INSURERS AFFORDING COVERAGE
NAIC#
UFARC Inc
1501 North Belcher Road
Clearwater FL 33765-1302
INSURER A:
INSURER B:
INSURER C
INSURER D:
INSURER E:
llHElRICAIf III'l'L SPI!:CIAL'l'Y LIlIES
EVEREST NATIONAL INS CO
E'IaEWUf I S Fum IrlSUIlAIICE: co
IlRIDGEI'2ELD 'CASUALTY :ms CD
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 NSRC TYPE OF INSURANCE POLICY NUMBER DATE (MMlDDIYY) DATE (MMlDDIYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1000000
'-
A X ~ COMMERCIAL GENERAL LIABILITY MZG80835863 12/01/04 12/01/05 PREMISES (Ea occurence) $ 1000000
::::J CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 10000
-
PERSONAL & ADV INJURY $ 1000000
X 10 DAY CIINC E'DR 11011 PAY GENERAL AGGREGATE $ 3000000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3000000
I n PRO- nLOC Emp Ben. 1000000
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $ 1000000
C ~ ANY AUTO CAOOOOO137041 12/01/04 12/01/05 (Ea accident)
ALL OWNED AUTOS BODIL Y INJURY
'- $
SCHEDULED AUTOS (Per person)
>--
~ HIRED AUTOS BODILY INJURY
(Per accident) $
~ NON-OWNED AUTOS
>-- PROPERTY DAMAGE $
X 10 DAY CIINC E'DR 11011 PAY (Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
q ANY AUTO OTHER THAN EA ACC $
AUTO ONL Y: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1000000
B ~ OCCUR D CLAIMS MADE BE3835173 12/01/04 12/01/05 AGGREGATE $ 1000000
$
~ DEDUCTIBLE $
X RETENTION $10000 $
WORKERS COMPENSATION AND X IT~R~LIMI'TS I IUER
D EMPLOYERS' LIABILITY 19603019 04/01/04 04/01/05
ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ 1000000
OFFICER/MEMBER EXCLUDED? 10 DAY Cl\IiIC E'OR 11011 PAY EL DISEASE - EA EMPLOYEE $ 1000000
If yes, describe under $ 1000000
SPECIAL PROVISIONS below EL DISEASE - POLICY LIMIT
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER IS NAMED ADDITIONAL INSURED ~TH RESPECTS TO GENEBAL
LIABILITY SUBJECT TO ALL TEBMS, CONDITIONS AND EXCLUSIONS OF THE FOLICY.
FAXED TO: 727-562-4825 ATTN: DEBBIE
CERTIFICATE HOLDER
XCITYOF
CANCELLATION
SHOULD /lJolY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 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.
AUTHO PR SENTATI
@ACORDCORPORATION 1988
CITY OF CLEARWATER
FARKS AND RECREATION DEFT
100 S MYRTLE AVE
CLEARWATER FL 33756-5520
ACORD 25 (2001/08)