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CERTIFICATE OF LIABILITY INSURANCE (5)OP ID: CA CERTIFICATE OF LIABILITY INSURANCE DATE F YY) 0 02/04/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER 727-797-044 CONTACT Connelly, Carlisle, Fields & 727 D673 669 PHONE N FAX _ - Nichols A/C o: o Ext : A/C N P.O. Box.1027 AIL ADDRESS: Clearwater, FL 33757 MichaelDevereux-. .; , PRODUCER CUSTOMER IDMYOUNG-8 . INSURERS AFFORDING COVERAGE NAIC # INSURED Young Women's Christian Assn INSURER A:Philadel hia Ins. Com anies 18058 Of Tampa Bay INSURERB:Pro ressive Commercial 10193 655 Second Avenue South INSURERC:Zenith Insurance Com an 13269 St. Petersburg, FL 33701 INSURER D INSURER E : INSURER F ; C©VERioCGES - GERTfFfCATE NUMBER: - REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LM TYPE OF INSURANCE B POLICY NUMBER MM DO/YYYY MMIDD/YYYY LIMITS . GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY PHPK662$16 01ID1/11 01/01/12 PREMISES E)RENTED a occurrence $ 100,00 CLAIMS-MADE Fx_]OCCUR MED EXP (Any one person) $ 5,00 PERSONAL & AOV INJURY $ 1,000,00 GENERALAGGREGATE $ 3,000,00 GEN-L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3,000,00 POLICY • PRO- .. LOC Emp Ben. - . , $ 1000000/1 AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT E id $ 300,00 11/08/10 11/08/11 ( a acc ent) B ANY AUTO 04743612-9 BODILY INJURY (Per person) $ ALL OWNED AUTOS F BODILY INJURY (Per accident) $ X SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Per accident) $ NON-OWNED AUTOS w $ X UMBRELLA LIAR X OCCUR OR?y V pu4?1 L 9 EACH OCCURRENCE $ 1,000,00 EXCESSLIAB CLAIMS-MADE r ' tea A ? F " 1 " y ii 9 { d 1/12 AGGREGATE $ 1,000,00 --.. ?_..?_._. DEDUCTIBLE _ W - I HU M01L9? _.. . ..- $ X RETENTION 10 000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC STATU- OTH- LIMI?S C ANY PROPRIETOR/PARTNER/EXECUTIVE FYIN - N / A Z070772001 06/24/10 06/24/11 E.L. EACH ACCIDENT $ 1,000,0D OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes, describe underr DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace la required) CERTIFICATE HOLDER CANCELLATION CITYO-4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Clearwater Official ACCORDANCE WITH THE POLICY PROVISIONS. Records and Legislative SVCS Cyndle Goudeau City Clerk AUTHORIZED REPRESENTATIVE P.O. Box 4748 n Clearwater, FL 34618 ?I ACORD 25 (2009/09) 01988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD OP ID: CA '4 RRO? CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY) 021/04/104/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER 727-797-0441 NAME: ACT Connelly, Carlisle, Fields & 727 0673 669 PHONE FAX - - Nichols A/C No Ext : AIC No); P.O. Box 1027 ADDRESS: Clearwater, FL 33757. - PRODUCER YOUNG 8 Michael Devereux - CUSTOMER ID #: INSURERS AFFORDING COVERAGE NAIC # INSURED Young Women's Christian Assn INSURER A;Philadelphia Ins. Companies 18058 Of Tampa Bay INSURER a:Pro ressive Commercial 10193 655 Second Avenue South INSURER C :Zenith Insurance Company 13269 St. Petersburg, FL 33701 INSURER D INSURER E : INSURER F : CAVFRAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IL SR TYPE OF INSURANCE POLICY NUMBER EFF MM D?/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY h,. . EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY PHPK662816 REC, ? Q?U/01/11 , 01/01N2 PREMISES Es occurrence $ 100,00 CLAIMS-MADE FxIOCCUR MED EXP (Any one parson) $ 6,00 PERSONAL & ADV INJURY $ 1,000,00 FED 1'j 21 11 GENERAL AGGREGATE $ 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS - COMPIOP AGG $ 3,000,00 POLICY PRO- LOC OFFICIAL RECOR S ANi° ' - Emp Ben. $ 100000011 AUT OMOBILE LIABILITY LEVISEXTINIC V S DEN COMBINED SINGLE LIMIT (Ea $ 300,00 11/08/10 11/08/11 B ANY AUTO 04743612-9 BODILY INJURY (Per person) BODILY $ ALL OWNED AUTOS BODILY INJURY (Per accident) S X SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 :..__ . EXGE55_lIAB_...... CLAIMSy1ADE - - - _ ?:: _ _ - _- 01/01/11 - - - - - ` 01/01/12 AGGREGATE ._$. -11-,000,-000 A DEDUCTIBLE P}i U B330129 $ X RETENTION $ 10,000 $ WORKERS COMPENSATION ' WC STATU- OTH- C LIABILITY AND EMPLOYERS YIN ANY PROPRIETOR/PARTNER/EXECUTIVE Z070772001 06/24/10 06/24/11 E.L. EACH ACCIDENT $ 1,000,00 ? OFFICERIMEMBER EXCLUDED? (Mandatory in NH) N / A E.L. DISEASE - EA EMPLOYEE $ 1,000,00 It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more apace Is required) CERTIFICATE HOLDER CANCELLATION CLEARW6 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANf1J06FAWRE THE EXPIRATION DATE THEREOF, NOTICE WIU_CWdftffMAft Clearwater Police Department ACCORDANCE WITH THE POLICY PROVISIONS. Chief Of Police EEB 1 2 0 11 Sid Klien AUTHORIZED REPRESENTATIVE - - 645 Pierce Street ? ? MMWGWN Clearwater, FL ` o('"_ 9173 ACORD 25 (2009/09) Z.c.4- 01988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD