CERTIFICATE OF INSURANCE
ACORD.
CERTIFICATE OF LIABILITY INSURANC~d8N~8 DA~E~~~770)3
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.
PRODUCER
Carlisle Fields & Company, Inc
P.O. Box 7910
Clearwater FL 33758-7910
Phone:727-797-0441 Fax:727-725-3663
INSURERS AFFORDING COVERAGE
INSURED
INSURER A:
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
Zenith Insurance Compan
Markel Insurance Com any
Pro ressive Commercial
Young Women's Christian Assn
Of T~a 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 CONDITION OF AtN CONTRACT OR OTHER DOCUMENT Willi 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.
IIJIISR TYPE OF INSURANCE POLICY NUMBER PO~~ POL1C:~IEXP~rrffmN LIMITS
LTR DATE MMID DATE MMID
~NERAL lIABILITY EACH OCCURRENCE $ 1000000
B COMMERCIAL GENERAL LIABILITY TBD 10/01/03 10/01/04 FIRE DAMAGE (Anyone fire) $ 100000
I CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $ 5000
PERSONAL & ADV INJURY $1000000
-
GENERAL AGGREGATE $3000000
-
GEN'L AGGREGATE LIMIT An PER: PRODUCTS-COMP~PAGG $ 3000000
I n PRO- ,
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $1000000
C ANY AUTO 04743612-1 10/01/03 10/01/04 (Ea accident)
-
ALL OWNED AUTOS BODILY INJURY
- $
-..!. SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY
- $
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $ 1000000
B =:J OCCUR D CLAIMS MADE TBD 10/01/03 10/01/04 AGGREGATE $ 1000000
$
=l DEDUCTIBLE $
RETENTION $ 10000 $
WORKERS COMPENSATION AND I TORY LIMiT;] IU~~-
A EMPLOYERS' LIABILITY Z049904501 06/24/03 06/24/04 E.L. EACH ACCIDENT $ 500,000
E,L. DISEASE - EA EMPLOYEE $500,000
E,L. DISEASE. POLICY LIMIT $ 500,000
OTHER
DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLESlEXCLUSlONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Certificate holder is listed as an additional insured.
*30 Days Cancellation applies to Worker's Compensation Policies, 10 Days
Cancellation for all other policies - Applies to Florida Employees Only.
CERTIFICATE HOLDER I Y 1 ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
CITYC-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
-
City of Clearwater NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHAll
City Attorneys Office IMPOSE NO OBlIGATION OR lIABlLITY OF AtN KIND UPON THE INSURER, ITS AGENTS OR
P.O. Box 4738 REPRESENTATIVES.
Clearwater FL 33758-4738 ~tlj/ (r;h/~JD
I
ACORD 25-5 (7/97) v V" . -- @ACORD CORPORATION 1988