CERTIFICATE OF INSURANCE (4)
C.llent
Sl::,tl~
3YOUNWOM
...
Al;ORDTM
CERTIFICATE OF LIABILITY INSURANCE
PRODUCER
HRH Company of Tampa
5405 Cypress Center
POBox 23968
Tampa, FL 33623
Drive
DATE (MMIDD/YY)
11/14/02
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.
iNSURED
Young Women's Christian
Association of Tampa Bay
655 Second Avenue South
St. Petersburg, FL 33701
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 CON OfT/ON 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 CON DfTlONS OF SUCH
i
I INSURERS AFFORDING COVERAGE
"~----~--i- ~ ~----~---,--~--
IINSURERA:Royal Indemnity Insurance Company
r INSURER B:progressi ve/Pers Lines ~--~~_=--~_~-
~uRERc:Royal Insurance Compa!1L___~_n_____.__.
i INSU~ER D:FCCI Insuranc~ CompanY___~.__________n
!INSURER E:Hartford
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
l~f~1 TYPE OF INSURANCE I POLICY NUMBER
A ! GENERAL LIABILITY R2SP243591
i?,1 CJMERCIAL GENERAL LIABILITY
L~ CLAIMS MADE[X] OCCUR
! i
....------.--J
~~J
,lc:JEN'L AGGREGATE LIMIT AP~S PER:
. l POLICyn j~gT I I LOC
B : AUTOMOBILE LIABILITY 047436120
iUx i ANY AUTO
[J ALL OWNED AUTOS
, i SCHEDULEOAUTOS
POLlCY.~FFECTI'!sIPOLlC,! ~XPIRATIONI
DATE ,MMIDD/YTlI DATE ,MM/DD/YY
10/01/02110}01/03
LIMITS
10/01/02 10/01/03
I
EACH OCCURRENCE : $1 , 000 , 000
FIRE DAMAGE (Anyone ('ret $3 00 000
ME 0 EXP (Anyone person) I $1 0 0 0 0
PERSONAL & ADV INJURY J $1, 000 ,.JU2.Q._
GENERAL AGGREGATE 1$3 l 000 , 000
PRODUCTS-COMP/OP ~~__ 000
I
,
COMBINED SINGLE LIMIT i $1 000 000
(Ea accident) .~~J__~.__,~___.___~
i X i HIRED AUTOS
iXl NON-OWNED AUTOS
r-.J--
I !
I GARAGE LIABILITY
~~ ANY AUTO
C i EXCESS LIABILITY IUG352768D
o OCCUR D CLAIMS MADE
I
,
r---,
L__J DEDUCTiBLE
I xl RETENTION $10000
D i WORKERSCOMP[;NSATICNAND 001WC01A38629
i EMPLOYERS' LIABILITY
10/01/02110/01/03
I
BODIL Y INJURY 1$
, (Per person) I
~~---'---r------__n-n-
I BODILY INJURY i$
(Per accident) I
-~----:--~-------~-
I' PROPERTY OAMAGE i $
(Per accident) !
I AUTO ONL Y - EA ACCIDENTI $
, I
OTHER THAN EA ACe I $
AUTO ONL Y: AGG , $
EACH OCCURRENCE.~ 000 , 000
AGGREGATE i $1, 000 , 000
I
..--U-
1$
r----------..-----,- --..--~--- ,.-------
I i $
I ; wc STATU- i 10TH-I
i ITORY L!.MlL~L-.l..EB../--c--_____
E.L. EACH ACCiDENT j $100 , 000
E.L.DISEASE-EAEMPL~~EEI $100, 000
E.L. DISEASE-POLlCYLIMI~ $5 0 0, 000
$1,000,000/$3,000,000
$2,000,000
06/24/02 06/24/03
!
A i OTHER Professional
E birectors & Offi
I
!
R2ST419372
NOA0004376
10/01/02 10/01/03
10/01/02 10/01/03
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Additional Insured
CERTIFICATE HOLDER
I ADDmONALlNSURED; INSURER LETTER:
CANCELLATION
Sid Klein, Chief of Police
Clearwater Policy Dept.
645 pierce Street
Clearwater r FL
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATETHEREOF,THE ISSUING INSURER WILLENDEAVOR TO MAIL3_o..... DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAi LURE TO DO so SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITSAGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVf
D z.:S. 1~~i'Tyt..-
I
ACORD 25-S (7/97)1 of 2
#S91039/M91001
DJM @ ACORD CORPORATION 1988
~-
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.
ACORD 25-5 (7/97)2 of 2 #891039 /M91 001