CERTIFICATE OF INSURANCE/GENERAL & AUTO LIABILITY
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2/09/88
ISSUE DATE IMM/DD/YYj
SHAFER-BROWN INS
P 0 'BOX 1328
CLEARWATER FL 34617
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THls CERTIFICATE IS ISSUE..., AS A MATTER OF INFORMATION ONLY
ArIIO; CONF,ERS NO RIGHTS UPON THE CERTIFICATE HOLOER. THIS
'CER1IFICATE OOES NOT AMENO, EXTEND OR ALTER THE COVER-
~.~AFFORDED BY THE POLICIES BELOW.
'COMPANIES AFFORDING COVERAGE
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COMPANY A CINCINNATI INS CO
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~:;Ol ' 'c' M~ANY B CINCINNATI INS CO
LETTER
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INSURED
PINELLAS YOUTH
POBOX 71
LARGO
FOOTBAL L :CON IN
FL 34294
COMPANY C
LETTER
COMPANY D
LETTER
COMPANY E
LETTER
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THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
PERIOD INDICATED. NOTWITHST"'NOING ANY ~EQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH
RESPECT TO WHICH THIS CERTIFiCATE :.lAY BE iSSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED
HEREIN IS SUBJECT TO ALL. THE TERl\olS, EXC"-USIONS, AND CO~JDITIONS OF SUCH POLICIES.
, co I POLICY EFFECTIVE POLICY EXPIRATION
J LTR TYPE OF INSURANCE POLICY NUMBER DATE IMM/DD/YYI DATE IMM/DD/YYI
GENERAL LIABILITY IAGL2984527 3/01/88 3/01/89 BOOILY
INJURY
LIABILITY LIMITS IN THOUSANDS
E~CH
OCCURI=IENCE
AGGREGATE
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PREMISES/OPERA TIDNS
UNDERGROUND
EXPLOSION & COLLAPSE HAZARD
PRODUCTS/COMPLETED OPERA TIONS
CONTRACTUAL
PROPERTY
DAMAGE
COMPREHENSIVE FORM
1:-.'
INDEPENDENT CONTRACTORS
BROAD FORM PROPERTY DAMAGE
BI & PO L '
COMBINED rO 0
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PERSONAL INJURY
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AGL2984527
3/01/88
3/01/89
BODILY
INJURY
(PER
'PERSONI
BODILY
INJURY
IPER
ACCIDENT)
ANY AUTO
ALi.'OWNED AUTOS ,.
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5.
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PROPERTY
DAMAGE
BI & PO
COMBINED
EXCESS LIABI L/TY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
BI & PO
COMBINED
1
1
I
1
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABI L1TY
STATUTORY
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OTHER
lEACH ACCIDENT! r.:
IDISEASE.POLICY L1MITl '.
(DISEASE.EACH EMPLOYEEI(,;"
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i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
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~ GREENWOOD PANTHERS FOR PRACTICE LOCATED
AT PHILLIP JONES PARK AND MARTIN LUTHER
CITY OF CLEARWATER
ATTN: LARRY DOWD
P 0 SOX 4748
CLEARWATER FL34618
SHOULO
BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY
WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO
THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO
MAIL SUCH NOTICE SHALL IMPO NO OBLIGATION OR LIABILITY OF
ANY KIND UPON THE COMP TS AGENTS REPRESENTATIVES.
AUTHORIZED REPRESENTAT
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STEPHEN D BROWN
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