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CERTIFICATE OF LIABILITY INSURANCE (20)ACC>R& CERTIFICATE OF LIABILITY INSURANCE OP ID SH DATE(MM/DD/YYYY) `L.? HEADS-2 12/21/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Brown & Brown Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 83 Park Place Blvd., Ste 101 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 2456 (33757-2456) ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Clearwater FL 33759 Phone:727-461 -6044 Fax:727-442-7695 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A Ace American Insurance Co 22667 INSURER B: opta comp, comp Options fta 10834 Head Start Child Development & Family Services INSURER C: 2210 T all Pines Dr. Ste 200 INSURER D: v- Lar o FL 33771 g -- 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSR TYPE OF INSURANCE POLICY NUMBER DATE MMD DATE MM/DD/YYYOY .. LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X X COMMERCIAL GENERAL LIABILITY G20400869 01/01/11 01/01/12 PREMISES(Eaoe?curence) $ 100000 --- --- T _ _ - =-- -- --- .-. ------ _ MEDEXP (Any one per80n) -- PERSONAL & ADV INJURY $1000000 X Prof/Sex Abuse GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG ^ $ 2 0 0 0 0 0 0 PRO X POLICY JE CT LQC Em Ben. 1M/ 1M AUT OMOBILE LIABILITY Cr COMBINED SINGLE LIMIT A X ANY AUTO CALHO8123032 X01/01/12 (Ea accident) $ 500000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS DEC 2 9 20' 0 (Per person) $ X HIRED AUTOS BODILY INJURY _? - X NON-OWNED AUTOS (Per accident) $ ' Y DAMAGE PROPE LEl3" LATIW SRVC S 1D`T 9 T (Per $ GARAGE LIABILITY ', AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR 17 CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE C, ? $ RETENTION $ i.. k ?$ WORKER AND EMP S COMPENSATION LOYERS' LIABILITY - X TORY LIMITS ER YIN YPROPRIETGfVPART?1ER7EXEC-UTIV FICER/MEMBER EXCLUDED? -OIB13-208D56r2-0-0- -- 0101/-11.. . 1 1[12-- -E _EA-cHACCIDENr andatory in NH) F E.L. DISEASE - EA EMPLOYEE $ 10 0 0 0 0 describe under PROVISIONS below SAsdIAL E.L. DISEASE - POLICY LIMIT $ 5 0 0 0 0 0 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Reference: 701 North Missouri, Clearwater. Certificate Holder is an Additional Insured only as respects General Liability. CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn: Earl Barrett P O Box 4748 Clearwater FL 33758 ACORD 25 (2009/01) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOD CLEA 24 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. ® 1988-2009 All riahts reserved The ACORD name and logo are registered marks of ACORD AcoRb" CERTIFICATE OF LIABILITY INSURANCE OP ID $H DATE(MMIOD/YYYY) `? HEADS-2 12/21/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Brown & Brown Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 83 Park Place Blvd., Ste 101 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 2456 (33757-2456) ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Clearwater FL 33759 Phone:727-461 -6044 Fax:727-442-7695 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Ace American Insurance Co 22667 _ INSURER B: opta comp, comp options dba 10834 Head Ptart Child Development & Fami ly Services INSURER C: m 2210 T all Pines Dr. Ste 200 _ INSURER D: Largo FL 33771 - 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD C/YYYY DATE MM/DD EXPIRATIONIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE _ $1000000 ? _A„ __.X- ,X- -COMMERCIAL,GEN€&AIL-LABILFFY- -ED{?8 .`-r.2'U4-69-'."..'--^.-J`_. ._..__ / r O01 i r ?n 01 v?. / ?2 C PREMISES Ea occurence 100000 $ CLAIMS MADE ? OCCUR MED EXP (Any one person) $ 5000 PERSONAL & ADV INJURY $ 1000000 X Prof/Sex Abuse _ GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2 0 0 0 0 0 0 - LOC X POLICY 71 PROJECT Em Ben. - - 1M/1M AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ r O O O O O A X ANY AUTO CALHO8123032 01/01/11 01/01/12 (Ea accident) j ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ ][ NON-OWNED AUTOS ?"'\ .F,? `t 1 (Per accident) ,?, 10 • PROPERTY DAMAGE $ rte" (Per accident) GA RAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO e °` 1 EA ACC OTHER THAN $ H I AUTO ONLY: AGG $ EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F7 CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION .? E LLT I - ER X TORY LIMITS '•I-j R/F-XE: _ ROPR: -FO .-(PAR , .. :.._ 01/1 -:------- - -- ,...._ - ID .. ' u Manda EMPLOYEE E.L. DISEASE - $100000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate holder is an additional insured for general liability only with regard to Sanderlin Center Playground - 918 Palmetto Street, Clearwater, FL CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITyOjrC 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 City of Clearwater IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ATTN Earl Barrett P O B 4748 REPRESENTATIVES. . . ox Clearwater FL 33758-4748 AUTHORIZED RRESENTATIVE ACORD 25 (2009/01) U C 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD