CERTIFICATE OF INSURANCE (2)
ACORDw
CERTIFICATE OF LIABILITY INSURANCl;oL8:~~ 1S DA~E~;~o;70)3
THIS CERTIFICATE IS ISSUED IS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICJ.t"E
HOLDER. THIS CERTIFICRE DOES NOT AMEND, EXTEND OR
ALTER THE COVERPGE AFFORDED BY THE POLICIES BELOW
PRODUCER
Bouchard-Starcrest
101 Starcrest Drive
POBox 6090
Clearwater FL 33758-6090
Phone: 727-447-6481 Fax:727-449-1267
INSURERS AFFORDING COVERPGE
INSURED
Golden Cougar Band
Boosters Inc
POBox 14923
Clearwater FL 33766
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
AMERICAN STATES INSURANCE CO
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.
II\IS~ TYPE OF INSURANCE POLICY NUMBER PO~lflMEFF~ P.r.kf~~MMJtiD1YYIN LIMITS
lTR DATE MM/DD
~NERAL LIABILITY EACH OCCURRENCE $1,000,000
A X COMMERCIAL GENERAL LIABILITY 01CL4079389 08/15/03 08/15/04 FIRE DAMAGE (Anyone fire) $200,000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $10,000
PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $1,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: .' PRODUCTS-COM~OPAGG $1,000,000
Xl ,nPRO- n , ",
X POLICY JECT lOC .-\.--
~TOMOBILE LIABILITY f ".,
- COMBINED SINGLE LIMIT $
ANY AUTO .. (Ea acdl.~enl)
- \:
- All OWNED AUTOS BODll Y I~URY
(Per pers ) $
SCHEDULED AUTOS .~
-
I-- HIRED AUTOS :r', c:eOD2URY
$
NON-OWNED AUTOS ," ~ nl)
I-- . \. :i\,';;',; .,,;.'
I-- .,' ,I(~ ;;,f.1;',,,,., PROPERTY DAMAGE $
,_., (Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
tJ OCCUR o CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I TORY lIMrrS I F-
I ER
EMPLOYERS' LIABILITY
F..l. EACH ACCIDENT $
E.l. DISEASE - EA EMPLOYEE $
E.l. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHIClES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER IS LISTED AS ADDITONAL INSURED AS REGARDS GENERAL
LIABILITY SUBJECT TO THE TERMS, CONDITIONS, AND EXCLUSIONS OF THE POLICY.
FAX: 727-562-4825
CERTIFICATE HOLDER I Y I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
CITY 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
CITY OF CLEARWATER NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE lEFT, BUT FAilURE TO DO SO SHALL
DIRECTOR OF PARKS & RECREATION IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
100 SOUTH MYRTLE AVENUE
CLEARWATER FL 33756 REPRESENTATIVES.
I AUTHO~
ACORD 25-S (7/97)
@ACORD CORPORATION 1988