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CERTIFICATE OF LIABILITY INSURANCE
Aco6a CERTIFICATE OF LIABILITY INSURANCE DATE tMMlDDlYYYn 06/22/2010 'PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 3031 N Rocky Point Drive W, Suite 700 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Tampa, FL 33607 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Attn: Heather Shannon 100445--Lead-09-10 INSURED All Children's Health System, Inc. All Children's Hospital, Inc. 501 6th Avenue South INSURERS AFFORDING COVERAGE INSURER A: Endurance American Specialty Insurance INSURER B: N/A... ------ INSURER C: kI A. - --- - N/A St. Petersburg, FL 33701 N/A INSURER D: .., / -- - - --f - INSURER E COVERAGES - -=--...- - ._...__... __.....2...__.....I THE . .. _. _..----....M......- _....._------- .. 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. CY EXPIRATION LTR' INSRD TYPE OF INSURANCE POLICY NUMBER -- - i PO cmM OECTIVE ` POLI OLI DATE IMMIM/YYYY1 LIMITS GENERAL LIABILITY EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED -? 1 --------- $ PREMISES(Ea occurrence) ?I CLAIMS MADE OCCUR MED EXP Any one person) PERSONAL 8 ADV INJURY ----- - h _-._ -..._....-.-._ GENERAL AGGREGATE I • s GENERAL AGGREGATE LIMIT APPLIES PER -- PRO- PRODUCTS - COMP/OP AG POLICY JECT LOC' _._.---- -------._......_..---- AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT I $ ANY O accident) ?.-.".. _........... -' ALL OWNED AUTOS B ODI IN URY Y $ L. . - SCHEDUL ED AUTOS J p erson HIRCp AUTOS I BODILY INJURY $ NON-OWNED AUTOS IPer accident) - PROPERTY DAMAGE - " ""'- (Per accident) i $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AU'rO OTHER THAN EA ACC $ AUTO ONLY, $ AGG A EXCESS ! UMBRELLA LIABILITY HLC10000852800 12/15/2009 12/15/2010 EACH OCCURRENCE $ 20,000,000 OCCUR X CLAIMS MADE LY AGGREGATE -^ f $ 20,000,000 DEDUCTIBLE j $ j . - .-_- ,_._..,.... _. - -- $ X RETENTION $ . . .._.- WORKER S COMPENSATION AND WC STATU- OTH- PC EMPLOYE RS' LIABILITY C' ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OF " __ E.L. EACH ACCIDENT FICER/MEMBER EXCLUDED? r I I N L. DISEASE - EA EMPLOYE •• $ (Mandatory in NH) If yes, describe under j -•-??---...?. $ SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT OTHER i i cam. - I IUN Ur UrtKA I IVNWLUUA I IUNSlVt:HICLI:WtcXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: Aquatic Pool Use Agreement, February 9, 2010 - February 8, 2011 CERTIFICATE HOLDER ATL-002143760-01 RECEIVE[ Mark Roberson, Recreation Supervisor 1 City of Clearwater, Parks and Recreation Department 101 N. Belcher oad Clearwa er. FL 33765 JUL 19 2010 ACOR 25 (2009/01 ..-...._- CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 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 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. UrrK?/? ppl??/^+ pp ¢ USAInc SFNTATIVE ?? ?' , M1. RIC% %J /-u adlTH a RShE ?E eather Shannon © 1998-2009 ACORD CORPORATION. All Rights Reserved The ACORD name and logo are registered marks of ACORD NAIC # 41718 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. 95 ronnainII ADDITIONAL INFORMATION PRODUCER Marsh USA, Inc. 3031 N Rocky Point Drive W, Suite 700 Tampa, FL 33607 Attn: Heather Shannon 100445--Lead-09-10 __._......_......-........._.....,.._.?......------- ------........------- FINSURED All Children's Health System, Inc. All Children's Hospital, Inc- 501 6th Avenue South St. Petersburg, FL 33701 ATL-002143760-01 INSURERS AFFORDING COVERAGE INSURER F: INSURER G: INSURER H: INSURER 1: NAIC # TEXT EVIDENCE OF COVERAGE WHILE PERFORMING PROFESSIONAL SERVICES WITHIN THE SCOPE OF EMPLOYMENT FOR ALL CHILDREN'S HEALTH SYSTEM, INC. PROFESSIONAL LIABILITY SUBJECT TO $2,000,000/$2,000,000 BUFFER SIR EXCESS OF A $3,000,000/$12,000,000 PL SIR. GENERAL LIABILITY SUBJECT TO $1,000,0001$2,000,000 SIR. THESE ARE POLICY LIMITS AND DO NOT APPLY TO INDIVIDUAL STAFF MEMBERS. UMBRELLA POLICY IS WRITTEN ON A CLAIMS MADE COVERAGE FORM (RETROACTIVE DATE 12/01/1975). i I, i j I I i CERTIFICATE HOLDER Mark Roberson, Recreation Supervisor 1 City of Clearwater, Parks and Recreation Department 1501 N. Belcher Road Clearwater, FL 33765 of MarORs U S?PInC5ENTATIVE of Heather Shannon MARSH USA. INC. 3031 N ROCKY POINT DRIVE W. SUITE 700 TAMPA, FL 33607 ATTN: HEATHER SHANNON 012839 MARK ROBERSON, RECREATION SUPERVISOR 1 M-012839 CITY OF CLEARWATER, PARKS AND RECREATION DEP 1501 N BELCHER RD CLEARWATER FL 33765-1339 32 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIAIIIIIIIIIIIIIIIIIIIIIIII 025993