CERTIFICATE OF LIABILITY INSURANCE (5)LMG 8/13/2010 11:41:49 AM PAGE 2/003 Fax Server
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plT THIS CERTIFICATE IS ISSUED AS A MATTER OFINFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CEERTIRCATE HOLDER
WELLS FARGO INS SVCS USA INC THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
PO BOX 1106 COVERAGE AFFORDED BY THE POLICIES BELOW.
CA 95945
GRASS VALLEY
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''SUFM American States Insurance Company 19704
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INSURER
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CLEARWATER HISTORICAL SOCIETY INC
PO BOX 175 INSURER
FL 34617
CLEARWATER C
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INSURER
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THE POLICIES OF INSURANCE LISTED BELOW HAVE 599 ISSU ED O THE INSURED NAMED ABOVE R THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY RE QUIRIE MENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CEFITIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJBCT TO ALL THE
TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGR EGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY POLICY
EFFECTIVE EXPIRATION
NSR LD TYPE OFINSURANCE POUCY NUMBER DATE D
AT
LIMITS
LTR M
YY
G ENERAL LIABILITY EACH OCCURRENCE $
A COMMUIGALGENERALUAB 01 CG11649390 1/20/2010 1/20/2011 DAMAGETO RENTED PREMISES a
CLAIMS MADERIOCCUR MED EXP A one pwam) $
PERSONALa ADV INJURY $
GENERAL AGGREGATE $
'LAG U ES PM PRODUCTS- COMP/OPAGG S
71 POUCY PROJECT LOC S
A UTOMOBILE UA BIUTY COM ON W SINGLE UMIT
A ANY AUTO 01 CG 11649390 1/20/2010 1/20/2011 (Ea acdderd) s 500 000
ALL OWNS) AUTOS BODILY INJURY
SCHEDULED AUTOS (Per P--) $
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (Per acct)
PROPERTY DAMAGE
(Per accident) $
G ARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN FA ACC S
AUTO ONLY: AGG
EX CESS LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MAD AUG 1 8 1010 AGGREGATE $
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DEDUCTIBLE OFFICIAL $
R ORDS ANC:'
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OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES/ EXCLUSIONS ADDED BY ENDORSEM ENT/ SPECIAL PROVISIONS
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
O - DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAM ED TO THE
Clearwater City LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION
Parks & Recreation Department OR UADUTY OF ANY KIND UPON THE COMPANY; ITS AGENTS OR REPRE-
100 S. Myrtle Avenue SENTATIVI
Clearwater, FL 33756 AUTHORIZED
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LMG 8/13/2010 11:41:49 AM PAGE 3/003 Fax Server
IMPORTANT
it the certificate holder is an ADDITIONAL INSURED, the pofcy(les) must be endorsed A statement
on thws certificate toes not confer tights to the cert'rfioste holder in lieu of such endorsement(s).
N SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this oertificaie does not confer rights 10 the certificate
holder in lieu of such endorsanwnl(s)_
DISCLAIMER
ACORN 25 (2001/08)
The Certificate al Insurance on the reverse side of this form does not constitute a contract between
the issuing inswer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or after the coverage afforded by the policies listed thereon.