CERTIFICATE OF INSURANCE (240)
? ~.
ACORD.
CERTIFICATE OF LIABILITY INSURANCE
OP ID C DATE (NMlDDiYYYY)
WESTC-3 05 17 04
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
At TER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
PRODUCER
Brandise & Martinet Insurance
2110 East Flaminqo Rd., #300
LB- Veqas NV 89119
P e:702-735-1933 Fax:702-796-1349
INSURED
INSURERS AFFORDING COVERAGE
INSURER A: Wes tort Insurance
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
NAIC #
Westcare Foundation, Westcare
NV, Westcare CA, Westcare AZ
Westcare FL, Westcar~ GA
300 East Charleston *201
Las Veqas NV 89104
COVERAGES
ll-lE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWlTl-lSTANDING
ANY ReQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR
MAY PERTAIN,ll-lE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL Tl1E TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAlO ClAIMS,
LTR NSRt TYPE OF INSURANCE POLICY NUMBER roATE ;MMlDori"ii DATE MMI~ LIMITS
~ENERAL UASIUTY EACH OCCURRENCE $1,000,000
I
IA X COMMERCIAL GENERAl LIABILITY TC32592582 05/12/04 05/12/05 PREMiSES(e;~) $100,000
I CLAIMS MACE ~ OCCUR MED EXP (Anyone person) $ 5,000
~ PROFESSIONAL LIAB PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $ 3,000,000
~
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMPIOP AGG $ 3,000,000
II POLICY n )~8T n LOC
~OMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
A ~ ANY AUTO TC32592582 05/12/04 05/12/05 (Ea accident)
ALL OWNED AUTOS BODILY INJURY
- (Per person) S
SCHEDULED AUTOS
-
~ HIRED AUTOS BODILY INJURY
I (Per accident) $
~ NON.QWNED AUTOS
PROPERTY DAMAGE
- (Per accident) $
-
RRAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EAACC $
AUTO ONLY, AGG $
EXCESSJUMBRELLA LIABILITY, ' EACH OCCURRENCE $
tJ OCCUR D CLAIMS MADE AGGREGATE $ ,
$
=J DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSAllON AND IrORYLlMrrS I IV1H-
ER
EMPLOYERS. UABIUTY E,L, EACH ACCIDENT $ I
ANY PROPRIETORIPARTNERlEXECUTIVE
OFFiCER/MEMElER EXCLUDED? E.L. DISEASE - EA EMPLOYEE S
If res, describe under E.L DISEASE - POLICY LIMIT ,$
S ECIAL PROVISIONS below
OTHeR ,
lESCRlPllON OF OPERA liONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAl,. PROVISIONS
:ERTIFICATE HOLDER
Pinellas Coun~y Dept of
Social Social Services
1100 Cleveland Street
C1earwater FL 33755
CANCELLATION
PINELLi SHOULD ANY OF Tl1E ABOVE DESCRIBED POUClES BE CANCELLED BEFORE THE EXPIRAnoN
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN i
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Bur FAILURE TO DO so SHALL
IMPOSE,NO OBUGATlON OR UABIUTY OF ANY laND UPON THE INSURER, ITS AGENTS OR i
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
.
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s),
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.