CERTIFICATE OF LIABILITY INSURANCE (4)R?
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CERTIFICATE OF LIABILITY INSURANCE oPID s (MMIDD/YYYY)
7
YO-. 1/20/10
PRODUCER 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. Sox 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 Ins. Companies
f/C.f
I INSURER B: Progressive Commercial 10193
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Yo g Women's Christian Assn
Of Tampa Ba
INSURER C:
655 Second Avenue South
FL 33701
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t
b INSURER D:
urg
ers
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e
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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS-
INbK
LTR ROW
NSR
TYPE OF INSURANCE
POLICY NUMBER POLICY EFFECTIVE
DATE MMIDDIYYYY PO
DATE MMIDDIYYYY
LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1000000
A X COMMERCIAL GENERAL LIABILITY PHPK3 7 3115 01/01/10 01/01/11 PREMISES Ea occurence) $ 100000
CLAIMS MADE X? OCCUR MED EXP (Any one person) $ 5 0 0 0
PERSONAL & ADV INJURY $ 1000000
GENERAL AGGREGATE w_ W$ 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 PRO LOC
JECT 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 E4 ACC $
H AUTO ONLY: AGG $
EXCESS I UMBRELLA LIABILITY
- EACH OCCURRENCE $1,000,000
A X OCCUR F
ICLAIMSMADE PHUB259124 01/01/10 01/01/11 AGGREGATE $1,000,000
DEDUCTIBLE $
X RETENTION $10,000 $
WORKER S COMPENSATION -
AND EMP LOYERS' LIABILITY TORY LIMITS ER
Y I N
ANY PROPRIETOR/PARTNER/EXECUTIV
F E.L. EACH ACCIDENT $
...-.:- OF
ICER/MEMBER EXCLUDED?
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, describe under
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SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT
OTHER Lp
RECE ED Rece'vad
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I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I L,?i1pV
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OFFICIAL RECORDS A
SRVGS DEVI
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY0 01-.5 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
City of Clearwater Risk Mgt
Janet Skinner REPRESENTATIVES.
645 Pierce Street AUTHORIZED REPRE NTATIVE
Clearwater FL 33756
ACORD 25 (2009101)
0 19W2QD *RPM.COReQRMCK-40rl§hfLmserved.
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.
PiECEfved
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ACORD 25 (2009/01)