CERTIFICATE OF LIABILITY INSURANCE (9)ACORD CERTIFICATE OF LIABILITY INSURANCE pp??
O DATEIIM)
FOUNVIL 01/14/10
VROU4yCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Greg Roe Insurance, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
9851 State Road 54 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
NeW Port Richey FL 34655
Phone:727-376-0030 Fax:727-376-2262 INSURERS AFFORDING COVERAGE NAIC9
INSURED INSURER A: At eats MW-- p,I?-V 04377
Foundation Village INSURER B_ Underwriters at Lloyd's
Neighborhood Family Center,Ina
Family Center Inc INSURER C:
918 WDodlawn b t .
Clearwater PL 33756 INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN LSSLEA TO THE INR(ED 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 TYPE OF INSURANCE POLICY NUMBER DWE PNObIM DATE (MI11110OM'Y) LOM
GENERAL LIABU?Y EACH OCCURRENCE $1,000,000
A X COMAERCIAL GENERAL LIABILITY NIAIS16658 10/01/09 10/01/10 PREMISE) $100,000
CLAIMS Mace NE OCCLit NEED EXP (Any v pweort) $8,000
PERSONAL & ADV INJURY $1,000,000
GENERALACC44EGATE $ 3,000,000
GENU AGGREGATE LIMIT APPLIES PER PRODUCTS - am yoP AGG s3,000,000
POLICY PPRRCO- LOC
HA11 0MOBLE MBILTTY COMBINED SINGLE LIMIT
000
000
$ 1
ANY AUTO (EaeWdDM) ,
,
ALL OWNED AUTOS
BODILY INJURY
$
A X SCHEDULED AUTOS NIA1816658 10/01/09 10/01/10 (Per"-)
A X HREDAInos RIAIS16659 10/01/09 10/01/10
BODILY INJURY $
A X NON OWNED AUTOS NIA1816658 10/01/09 10/01/10 (Peracci-)
PROPERTYDAMAGE
(Per accident) $
GARAOE UASRM AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
/AUTO ONLY: AGG $
EXCESSAIMBRELLA LMBILTTY EACH OCCURRENCE ;
OCCUR CLAIMS MADE AGGREGATE ?... $
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND
' TORY LIMBS ER
EWLOYERS
LUIORM
MJV PRIOPRIETORIPARTAER/EXEp1TIVE
E.L. FACH ACCIDENT
$
OFFICERMEMBER EXCLUDED?
If
E.L. DISEASE - EA EMPLOYEE
$
yes, describe Index
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$
OTHER
A
I Sexual/Prof Ziab NMUS16658 10/01/09 10/01/10 Sxl/Pros 1,000,000
S Building Covg 7255 02/22/09 02/22/10 Bldg Covg 303,000
DESCRIPTION OF 011MtATICIM I LOCATIONS I VEH:LES I EXCLUSKM ADDED BYE Nf IF SPELML PROVISIONS
*30 DAYS NOTICE OF CANCELLATION, E70ClPT 10 DRYS NOTICE OF CANCELL&TXON FOR
NON-PA7=17 OF PRE1,0M. FAXED TO HOLDER 727-562-4198.
CERTIFICATE HOLDER CANCELLATION
CITYPoL SHOULD ANY OF THE ABOVE DESC1418ED POLICES BE rAurv M BEFORE THE EXPIRATION
CITY OF CLE TER DATE TH EIM F. THE BRIM 818MR WLL ORNAVOR TO MAL * DAYS WRITTEN
POLICE DEPT NOTICE TO THE CEYTIIWIC 1TE HOLDER HAMM TO THE LEFT, BUT FAILURE TO DD SO SHALL
ATTN : CANT HALL WOSE NO OBLIGATM OR UABLRY OF ANY KBD UPON THE WAUR SK ITS AQWM OR
645 P13RCE ST
CLE TER FL 33756 ITATNEB
25(20M=) O ACORD
CITY OF CLEARWATER
JAN 2 Q 2(110
RISK MANAGEMENT
9173
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), auttrorize 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 (20011W
%-;nY of CLIARWATER
JAN2()ro11
RISK MANAGEMENT
9773