CERTIFICATE OF LIABILITY INSURANCE (3)C?/eb® CERTIFICATE OF LIABILITY INSURANCE OP ID Rs DATE(MMIDDIYYYY)
UPARC 1
j 08L06/10
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Bouchard-Clearwater ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
101 Starcreat Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P0 Box 6090 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater FL 33758-6090
Phone:727-447-6481 Fax:727-449-1267 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: oridgafiald Cuuelty Ins Co 103355
INSURER B: New Hampshire Insurance Cc 23841
UPARC Inc
Inc
U arc Foundation
INSURER C:
,
.
1901 North Belcher Road INSURER D:
Clearwater FL 33765-1302
_1 INSURER E:
17nVFRCQFA
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.
IMI
LTR
NSR
IIJ
TYPE OF INSURANCE
POLICY NUMBER
DATE MMIDOM'YY
DATE MMDDM'YY
LIMITS
GENERAL LABILITY EACH OCCURRENCE $ 1,000,000
B X COMMERCIAL GENERAL LIABILITY 01LX62640711000 12/01/09 12/01/10 PREMISES Eaoccurence $ 250,000
CLAIMS MADE FXI OCCUR MED EXP (Any one person) S 10,000
10 DAY CANC FOR NONPAY PERSONAL BADVINJURY s 1,000, 000
GENERAL AGGREGATE $ 3,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3,000,000
POLICY PEDT RA" Loc
J X Prof Liab 1,000,000
B AUT
X OMOBILE LIABILITY
ANY AUTO
OICA93485141000
12/01/09
12/01/10 COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
ALL OWNED AUTOS BODILY INJURY
§
SCHEDULED AUTOS 10 DAY CANC FOR NONPAY (Per person)
X
X HIRED AUTOS
NON-OWNED AUTOS ECENE BODILY INJURY
(Per accident)
$
G 18 201
DAMAGE
PROPERTY
$
U
er aciden
(P
GARAGE LIABILITY AUTO ONLY, EA ACCIDENT $
ANY AUTO OFFIC IAL RECORD AND OTHER THAN EA ACC $
LEVI LATNE SRV ?
DEPT AUTO ONLY: AGG S
EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ 2,000,000
B X OCCUR ? CLAIMS MADE 01UD07738931000 12/01/09 12/01/10 AGGREGATE s2,000,000
10 DAY $
DEDUCTIBLE CANC FOR $
X RETENTION $10,000 NONPAY $
WORKER
AND EMP S COMPENSATION
LOYERS' LIABILITY X TORY LIIA IMITS ER
A YIN
ECUTIV?
ANY
RIETOR
019603019
04/01/10
04/01/11
E.L. EACH ACCIDENT
$1,000,000
EXCLUD n7
FICER/MEMBE
(Mandatory In NH) 10 DAY CANC FOR MONPAY E.L. DISEASE - EA EMPLOYEE $1,000,000
11 yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$ 1 , 0 0 0 , 0 0 0
OTHER
DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITYCLE 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
100 S MYRTLE AVE REPRESENTATIVES.
CLEARWATER FL 3 3 7 6 5 AUTHaRRTHQRIED 9
NTATNE
E
ACORD 25 (2009/01)
®1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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