CERTIFICATE OF INSURANCE
ACORDTM
CERTIFICATE OF LIABILITY INSURANCE
DATE IMMIDDIYYI
07/18/03
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
PRODUCER
ACORDIA EAST - TAMPA BAY
P.O, Box 31666
Tampa, FL 33631-3666
727-796-6666
INSURED
Partners in Self Sufficiency
2960 Tanglewood Dr. Bldg H
Clearwater FL 33759
INSURER A:
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
INSURERS AFFORDING COVERAGE
AUTO OWNERS-09703
HARBOR SPECIALTY INS, CO.
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,
~~: TYPE OF INSURANCE POLICY NUMBER ~~Y EFFECTIVE POLICY EXPI~~~ LIMITS
A ~ERAL LIABILITY 2062094403 8/30103 8/30/04 F.ACH OCCURRENCE $ 1000000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any ooe fire) $ 100000
I CLAIMS MADE W OCCUR MED EXP (AnV one person) $ 10000
- PERSONAL & ADV INJURY $
- GENERAL AGGREGATE $ 2000000
n'L AGGREfi LIMIT APPl PER: PRODUCTS - COMP/OP AGG $ 2000000
POLICY P'~RT LOC
~TOMOBILE L1ABIUTY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
t--
I--- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
t--
t-- HIRED AUTOS 1l0DIL Y INJURY
$
NON-OWNED AUTOS IPer accident)
I---
t-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
o OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
B WORKERS COMPENSATION AND 4959202 12/07/02 12/07103 X l.ro~,n~~;, I IO~-
EMPLOYERS' L1ABIUTY
EL. EACH ACCIDENT $ 100000
E.L. DISEASE - EA EMPLOYEE ,a...... .. A mAi~9
E.L. DISEASE - POLlCY'OO N"",,;a. 500000
OTHER
)ESCRIPTION OF OPERATIONS/LDCATIONSNEHICLESIEXCLUSlONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CLEARWATER HOUSING AUTHORITY IS NAMED AS ADDITIONAL INSURED AS
RESPECTS TO GENERAL LIABILITY ONLY
~ ; ,,' ,,. '.
.." "
:ERTIFICATE HOLDER I 1 AOOmONAl INSURED; INSURER LETTER: CANCELLA TION'--- f ,: !' ,....
, i .'
CLEARWATER HOUSING AUTHORITY SHOULD ANY OF THE ABO-iE:]).ESCFUlIEDpOucies BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER wiLL ENOEAVQR TO MAIL ---1.Q.. DAYS WRITTEN
3250 5TH A VENUE NORTH NOTICE TO THE CERTIFICATE HOLDER NAME!> TO THE LEFT, BUT FAILURE TO DO SO SHALL
ST PETERSBURG, FL 33717 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS DR
REPRESENTAfWe . /J -
AUT~ ." ~V/
I
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