CERTIFICATE OF INSURANCE (201)
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ISSUE DATE (MMIDOIYY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOlDER. THIS CERTIFICATE DOES NOT AMEND,
.EXTEND OR AI.. TER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Crossing
IN. 46206
CODE
~ANY A
COMPANIES AFFORDING COVERAGE
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CIGNA Insurance Group
INSURED KIWANIS INTERNATIONAL.
ALL CLUBS AND THEIR MEMBERS.
INSURED LOCAL CLUB: KIWANIS CLUB OF
CLEARWATER EAST
ADDRESS: PO BOX 5024
.CLEARWATER"FL 34618
~ANY B
~ANY C
OGTl 15 1930
~ANY D
CQoiPNiY ,"
LETTER E
crrY; CLERK
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THIS IS TO CERTIFY THAT 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
CERTIACATE 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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TR
TYPE OF INSURANCE
POLICY MUllBER
! ---,--~---:------------~--_._-----_.._---_.._-
" POLICY EFFECTIVE iPouCY EXPIRATION' ALL UIIITS IN ........_a......
I DATE (MMlDDIVY) 1 DATE (MMlDDIVY) 1 .....=-==--_
11-01-90 ! :==~i AGGREaATI:~~t"ggg-'i
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i PERSONAL & ADVERTISING INJURY 1 1 000 !
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I EACH OCCURRENCE . 1 1 , ()..Q9.._ I
., FIRE DAMAGE (Any _lire) ,._-,!_--2Q..,_ i,
, MEDICAl. EXPENSE (Any _ peraon) , 1 I
11-01-90 15~ED 111,000--'---
11-01-89
: GENERAL LWlIUTY ,
A X COMMERCIAL GENERAL UABIUTY ..
C~~.'-i CLAIMS MADE'=_; OCCUR.
, . OWNER'S & CONTRACTOR'S PROT.
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OGL Gl 07 90 499
! AUTOIIOBlLE UABIUTY
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ANY. AUTO
OGL Gl 07 90 499
11-01-89
ALL OWNED AUTOS
OTHER THAN UMBRELLA FORM
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i BODILY !
i INJURY i 1
! (Per person) !
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! BODILY
j INJURY ! 1
! (per accIclent)
i . SCHEDULED AUTOS
~ HIRED AUTOS
i X' NOf<<>WNED AUTOS
, GARAGE LIABILITY
-
WORKER'S COMPENSATION
AND
EMPLOYERS' UABIUTY
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! PROPERTY : 1
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i 1 j (DISEASE-4'OLJCY UMIl)
! . ! 1 i (DISEASE.::eACH 'EMPLOYE
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DESCRlPTIONOFOPERAT1ONSlLOCA ITEIIS All operations and locations of Named Insureds
arising out of Kiwanis sponsored activities or events. PERSONS OR ORGANIZATIONS granting
use of premises or facilities to Kiwanis or any local Club are ADDITIONAL INSUREDS as
re ards their liabilit out of the use of their premises or facilities by Kiwanis.
""">Cr TE~,,~~y~./
CITY OF CLEARWATER
112 OSCEOLA AVENUE SOUTH
CLEARWATER" FL 34616
SHOUlD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL -.!.Q... DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR !tEPRESENTATIVES.
25-5 (3118)
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:i.~-ACORD CORPORATION 1188
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