CERTIFICATE OF LIABILITY INSURANCE (8)14795
ACOPD
CERTIFICATE OF LIABILITY INSURANCE D/YYYY)
DATE
TM 6
/3/2
6/3/2009
PRODUCER Commercial Lines - (727) 796-6666 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Wells Fargo Insurance Services Southeast Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
311 Park Place Boulevard, Suite 400
Clearwater, FL 33759-3923 INSURERS AFFORDING COVERAGE NAIC #
INSURED Ruth Eckerd Hall, Inc. INSURER A: American Zurich Insurance Company 40142
1111 McMullen Booth Road INSURER B: Zenith Insurance Company 13269
{/ ?lf INSURER C:
INSURER D:
Clearwater, FL 33759 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 Pb LICY EFFEGTNE POLICY EXPIRATION LIMITS
A GENERAL LIABILITY CP0278060506 05/31/09 05/31/10 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000
.CLAIMS MADE POOCCUR MED EXP (Any one person) $ 10,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
PRD X LOC
POLICY
[7 JE
A AUTOMOBILE LIABILITY CP0278060506 05/31/09 05/31/10 COMBINED SINGLE LIMIT
X ANY AUTO (Ea accident) $ 1,000,000
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS ' (Per person) $
X
HIRED AUTOS
Jul
?-'
aos
BODILY INJURY
X
NON OWNED AUTOS
G (Per accident) $
PROPERTY DAMAGE
$
G l . r _ (Per accident)
GARAGE LIABILITY ..-.-----•-' - 77'?--_ --~?~ AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A EXCESS/UMBRELLA LIABILnY UMB967294101 05/31/09 05/31/10 EACH OCCURRENCE $ 10,000,000
X OCCUR FICLAIMS MADE AGGREGATE $ 10,000,000
DEDUCTIBLE $
X RETENTION $ 0 $
B
WORKERS COMPENSATION AND
2836094215
01/01/09
01/01/10 X WG STATU- OTH-
ToRYLIMIT ER
- ---
EMPLOYERS'LIABILITY
ANY PROPRIETOWPARTNEWEXECUTIVE --` - - -•'- -
-E:L. EACH-ACGIDENT-
$1,000,000_
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1,000,000
If yes, describe under
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000
OTHER
r._ o.ti w ' r?
a
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES ! EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
CITY IS ADDITIONAL INSURED FOR INTEREST HELD IN PREMISES OF RUTH ECKERED HALL. J ON 0 4 , 403' "-s
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UbK I IrIUA I t HULIJhK L:AN(;ItLLA I IUN 1-1 -y 1-1- - ay-Ul rt
CITY OF CLEARWATER
ATTN: LEO SCHRADER, RISK MGMT
P O BOX 4748
CLEARWATER FL 33758-4748
ACC)Rn 25 f2nnimm 4 _F f
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL " DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED REPRESENTATIVE
n AP_ARI'1 rARPARATIAAI 4GRR
V
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-S (2001/08) 2 of 2 #S915260/M915043
14795
/3/2DIYYYY)
6/3/2009
ACO"RM CERTIFICATE OF LIABILITY INSURANCE 6 DATE
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Commercial Lines (727) 796-6666 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Wells Fargo Insurance Services Southeast Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
311 Park Place Boulevard, Suite 400
Clearwater, FL 33759-3923
INSURED Ruth Eckerd Hall, Inc.
1111 McMullen Booth Road
Clearwater, FL 33759
r_nVFROrFS
INSURERS AFFORDING COVERAGE NAIC #
INSURER A. American Zurich Insurance Company 40142
INSURER B: Zenith Insurance Company 13269
INSURER C'
INSURER D:
INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMkU AbVV t t-Um 1 nt ruin, r
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, E
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY EFFECTIVE POLICY EXPIRATION
T IL TYPE OF INSURANCE POLICY NUMBER DAIE (MWDDMI DATE (MMIQDIYYI-
A GENERAL LIABILITY CP0278060506 05/31/09 05/31/10
X COMMkRCIAL GENERAL LIABILITY
CLAIMS MADE FTIOCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
n PRO- X LOC
POLICY I I JFCT.
A AUTOMOBILE LIABILITY
X ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
X HIRED AUTOS
X NON-OWNED AUTOS
GARAGE LIABILITY
7 ANY AUTO
05/31/09 05/31/10
? . loos
-777
A EXCESS/UMBRELLA LIABILITY UMB967294101 05!31109 05131/10
X OCCUR CLAIMS MADE
DEDUCTIBLE
X RETENTION $ 0
ON / lu-
B WORKERS COMPENSATION AND Z836094215 04/01/09 -
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
for your information only
L
City of Clearwater
P O Box 4748
Clearwater FL 33756
ACORD 25 (2001/08) 1 of 2
PERIOD INDICATED. NOTWITHSTANDING
5 CERTIFICATE MAY BE ISSUED OR
(CLUSIONS AND CONDITIONS OF SUCH
LIMITS
EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED $ 100,000
MED EXP (Any one person) $ 10,000
PERSONAL 8 ADV INJURY $ 1,000,OOD
GENERAL AGGREGATE $ 2,000,000
PRODUCTS - COMP/OP AGG $ 2,000,000
COMBINED SINGLE LIMIT $ 1,000,000
(Ea accident)
BODILY INJURY $
(Per person)
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE $
(Per accident)
AUTO ONLY - EA ACCIDENT $
EA ACC $
OTHER THAN
AUTO ONLY: AGG $
EACH OCCURRENCE $ 10,000,000
AGGREGATE $ 10,000,000
$
$
X WC STATU- OTH-
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE - EA EMPLOYE E $ 1,000,000
E.L. DISEASE - POLICY LIMIT $ 1,000,000
t,-'t.a Lt 6 ;771
..
JUN 4 Zo"Vl
. . ...........w.ua-f:,_1Y1
CANCELLATION Ten Day Notice for Non-Payment
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO MAIL 90 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.
AUTHORIZED REPRESENTATIVE
571166 ?;j? ?+•i 0 ACORD CORPORATION 198E
r
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-S (2001/08) 2 of 2 #5915250/MVI 04.143