CERTIFICATE OF LIABILITY INSURANCE (7),aco?roT CERTIFICATE OF LIABILITY INSURANCE Date (mm/dd/yy)
1/27/2011
Producer THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
WELLS FARGO INS SERVICES USA ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
THIS CERTIFI
PO BOX 30001 CATE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW.
TAMPA, FL 33630 SURE AFFORDING COVERAGE AIC #
INSURER American States Insurance Company 19704
A
INSURER
Insured B
CLEARWATER HISTORICAL SOCIETY INC
PO BOX 175 INSURER
CLEARWATER, FL 34617 C
INSURER
D
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 INSURANC E 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.
POLICY POLICY
INSR pD EFFECTIVE EXPIRATION
LTR INSD TYPE OF INSURANCE POLICY NUMBER DATE DATE LIMITS
MM/DD YY /DD YY
A
/ G ENERAL LIABILITY EACH OCCURRENCE $
t COMMERCIAL GENERAL LIAB 01 CG 11649300 1/20/2011 1/20/2012 DAMAGE TO RENTED PREMISES $
CLAIMS MADEF,71OCCUR
MED EXP (Arry one person) S
PERSONAL & ADV INJURY S bUU
UUU
,
GENERAL AGGREGATE $
GEN'L A LIMIT APPLIES R
PRODUCTS - COMP / OP AGG $
71POLICY PROJECT LOC $
A A UTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO 01 CG 11649300 1/20/2011 1/20/2012 (Ea accident) $ 500,000
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS
\
/ (Per person) $
HIRED AUTOS 10 C ?
P
? BODILY INJURY
NON-OWNED AUTOS p (Per accident) $
PROPERTY DAMAGE
(Per accident) $
G ARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
- AUTO ONLY: AGG $
EXCESS LIABILITY r EACH OCCURRENCE S
OCCUR CLAIMS MADE p K;,IS, a S VCS DE AGGREGATE $
DEDUCTIBLE S
RETENTION $ S
WORKERS' COMPENSATION &
E
M
O
Y
E
R
S' LIA
Y
PLL
BIILIIT WC Statutory Limit other
P
N
Nyy
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pp
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g
N
R?
B
E? ECUTIV
O
VO E
EL EACH ACCIDENT
$
FFICER/M
XCLt1
E
??describe dder EL DISEASE - EACH EMPLOYEE $
PR N5 below EL DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Certificate Holder is listed as an Additional Insured by written contract, agreement, permit or schedule,
CERTIFICATE, HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
City of Clearwater LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION
Parks and Recreation Dept
PO BOX 4748 OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRE-
Cl SENTATIVES.
earwater, FL 33758 AUTHORIZED
REPRESENTATIVE
ACORD 25 (2001%08) , Insurance Visions, Inc, 0 ACORD CORPORATION 1988