CERTIFICATE OF LIABILITY INSURANCE (15)R? CERTIFICATE OF LIABILITY INSURANCE OP ID SA DATE(MMIDDIYYYY)
YOUNG $ 01 20 10
P DUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Carlisle Fields & Company, LLC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 1027 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater FL 33758-7910
Phone:727-797-0441 Fax:727-725-3663 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Philadelphia las. Companies
INSURER B: Progressive Commercial 10193
Young Women's Christian Assn
Of Tam
a Bay INSURER C:
p
655 Second Avenue South INSURER D:
St. Petersburg FL 33701 --
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-
INZiK NSR TYPE OF INSURANCE POLICY NUMBER DI MMIDDIYYYY DATE MMID? LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1000000
A X COMMERCIAL GENERAL LIABILITY PHPK3 7 3115 01/01/10 01/01/11 PREMISES (Ea occurence) $ 100000
CLAIMSMADE [K .OCCUR MED EXP
(Any one person)
$ 5000
. ... .. PERSONAL & ADV INJURY $ 1000000
GENERAL AGGREGATE $ 3 0 0 0 0 0 0
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3 0 0 0 0 0 0
X POLICY JEC LOC EM Ben. 1000000/1
AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT
$ 300000
B ANY AUTO 047436128 11/08/09 11/08/10
(Ea accident)
ALL OWNED AUTOS BODILY INJURY
$
X SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY
$
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY, AGG $
EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ 11000,000
A X OCCUR F7 CLAIMSMADE PHUB259124 01/01/10 01/01/11 _
AGGREGATE $1,000,000
J $
DEDUCTIBLE $
FX1 RETENTION $10,000 - $
WORKERS COMPENSATION
'
TORY LIMITS ER
AND EMPLOYERS
LIABILITY Y / N
---
-ANY-RROPRIETORFPARTNERAEXEGUTIV :_--_-,.- LrEACH- ACI+ACCIDENT=.. ::....__......-
OFFICER/MEMBER EXCLUDED?
mNH)
(Mandatory E.L.
DIS SE - EA EMPLOYEE S LL .,_...
If yas, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$
OTHER
NMI im
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS
JAN 23 2010
OFFI
CERTIFICATE HOLDER CANCELLATION LEGISI ATIVF CD\/r`C r1FP'
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITYO- 4 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 210 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Clearwater Official IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Records and Legislative SVCS
k
i REPRESENTATIVES.
Cyndie Goudeau C
ty Cler ORIZED REPRE NTATIVE
T
P.O. Box 4748 AU
H
learwater FL 34618
ACORD 25 (2009/01) 0 19W21FOOMpM.CORepI` PMWK-110"ms.Lwerved.
The ACORD name and logo are registered marks of ACORD
t . --
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)