The URL can be used to link to this page

CERTIFICATE OF LIABILITY INSURANCE (19)A rn p?® /`? RJ/C CERTIFICATE OF LIABILITY INSURANCE OP ID SH DATE (MM/DD/YYYY) ? EiEADS- 2 12/04/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Brown & Brown Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 17757 US Highway 19 N, Ste 660 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 2456 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Clearwater FL 33757-2456 Phone: 727-461-6044 Fax:727-442-7695 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Ace American Insurance Co 22667 INSURER B: Zenith Insurance Company - 1 3269 Head Start Child Development . & Family Services INSURER C: _ 2210 Tall Pines Dr. Ste 200 INSURER D: Lar o FL 33771 -- g 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 DATE MMIDD POLICY EXPIRATION DATE MMIDDFAW LIMITS GENERAL LIABILITY EACH OCCURRENCE $1000000 A X X COMMERCIAL GENERAL LIABILITY G20400869 01/01/10 01/01/11 GE-TO PREMIS ES Eaoccurence) $ 100000 CLAIMS MADE- X-] OCCUR - ..-. __.....__....-. ... _.-- _- _ _-._ -. ". -- -_- -...:..-_ .---,-----,.•--__-:: .. MEDEXP-(Angoneperson)-... . ..$-500D PERSONAL & AOV INJURY $ 1000000 X Prof/Sex Abuse GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2 0 0 0 0 0 0 X POLICY jE LOC Emp Ben. 1M/ 1M AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT A X ANY AUTO CALH08123032 01/01/10. 01/01/11 (Ea accident) $ 500000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS ??9 (Per accident) $ +y PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO G(? EA ACC OTHER THAN $ O K?;R 1 .4 AUTO ONLY: AGG _ $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE G\? \?1(7 D AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X T LIMITS ER B ANY PROPRIETORlPARTNER/EXECUTIVEn CERlMEMBER EXCLUDED? OFF `- - - Z O 7U 0827 0Z - - -01/0-1/10- - " 0-1 /?1 /"11"- -E:L:EACH CH-ACEtDEtdT-- _T- $- -100 000- -- - - (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $100000 If describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 5 0 0 0 0 0 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate holder is an additional insured for general liability only with regard to 701 N. Missouri., Clearwater, FL CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION C 3:TxOFC DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City of Clearwater IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ATTN: Earl Barrett P O Sox 4748 REPRESENTATIVES. . . Clearwater FL 33758-4748 AUTHOR D REPRESENTATIVE wc;UKU Z* JZUUVIUi) Cl %) 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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 This Certificate of Insurance 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 (2009101) R? CERTIFICATE OF LIABILITY INSURANCE OPID SH DATE(MMIDDIYYYY) v HEADS-2 12/04/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Brown & Brown Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 17757 US Highway 19 N, Ste 660 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 2456 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Clearwater FL 33757-2456 Phone: 727-461-6044 Fax:727-442-7695 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Ace American Insurance Co 22667 INSURER B: Zenith Insurance Company 13269 Head Start Child Development & Family Services INSURER C: 2210 Tall Pines Dr. Ste 200 _ INSURER D: Largo FL 33771 1 INSURER E: Cr)VFRAAFS 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- LTV NSR UU TYPE OF INSURANCE - POLICY NUMBER POLICY EFFECTIVE DATE MM/DDIYYYY POLICY EXPIRATION DATE MIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 0 0 0 0 0 0 A X X COMMERCIAL GENERAL LIABILITY G20400869 01/01/10 01/01/11 UAMAQ1t UK _N1 PREMISE S(Eaoccurence $ 100000 CLAIMS MACE ® OCCUR - - - - MED EXP (Any one person) $ 5 0 0 0 PERSONAL & ADV INJURY $ 1000000 X Prof/Sex Abuse GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2 0 0 0 0 0 0 X POLICY PROCT LOC JE Emp Ben. 1M/ 1M AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $500000 A X ANY AUTO CALH08123032 01/01/10 01/01/11 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS NON-OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ D C (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ 'I n, Pr AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ _ OCCUR F_1CLAIMS MADE R ' AGGREGATE $ CITY ?.? CL1ARV. AE T $ ---- DEDUCTIBLE FNGIF E1 1IG DF,'ARTI RETENTION $ $ WORKERS COMPENSATION IABILITY O S' WCSTATU- TORY LIMITS ER X _ B- - AND EMPL YER L - yJN -ANY PRORRIETOR/PARTNEFyEXEC,IJTIV ,5---_" Z O.?I O O H 2 7 O 2 01/01/10 01/01/11 .L. EACH ACCIDENT E $ 100000 OFFICER/MEMBER EXCLUDED' . u (Mandatory in NH) E.L. DISEASE =fA EMPLOYEE - $ 3r0 0 0-0-0-_- If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 5 0 0 0 0 0 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate holder is an additional insured for general liability only with regard to Sanderlin Center Playground - 918 Palmetto Street, Clearwater, FL CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION `,iTyo1,.`+ DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City of Clearwater IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ATTN Earl Barrett REPRESENTATIVES. P.O. Box 4748 AUTHOR DRE RESENTATIVE Clearwater FL 33758-4748 ACORD 25 (2009/01) el ©1988-2009 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD y. 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 This Certificate of Insurance 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. Zsi ACORD 25 (2009/01)