CERTIFICATE OF LIABILITY INSURANCE AND EVIDENCE OF PROPERTY INSURANCEACORD CERTIFICATE OF LIABILITY INSURANCE OP IDAD DAIS PM001TVT)
FOUNVIL 03/17111
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Greg Roo Insurance, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
9851 State Road 54 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
New Port Richey FL 34655
Phone: 727-376-0030 Fax: 727-376.2262 INSURERS AFFORDING COVERAGE NAIC #
WSURFD INSURER A: mwspese irrlrMrr a?a.ly 04377
INSURER e: Underwriters at Lloyd's
Foundation Village
Neighborhood Family Ctr, Inc. INSURER C:
918 Woodlawn St. RS
R
Cl
t
FL 33756-2157 U
ERD:
earwa
er
wSUReR E:
COVERAGES
THE POLICIES OF INBURANOE LISTED BELOW HAVE BEEN ISSUED TO THE NSLIRED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUENT WTH RESPECT TO WOCH THIS CERTIFICATE WAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IB SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOM MAY HAVE BEEN REDUCED BY PAID CLAUS.
INSR DL POLICY EFFECTIVE POLICY EXPIRATION
LTR aw TYPE OF INSURANCE POLICY DUMBER DATE IWNDDNVI GATE L ARTS
GENERAL LABLITY EACH CCCURRENCE S 1,000,000
A
X
X
COMMERCALGENERAL LLIBILITY
NIA1816799
10/01/10
10/01/11 DAMAGE TO RENTED
FROMM$(Es
Rlow.no.) i
LOO
,000
CLAIMS MADE F OCCUR MED EXP OM-p-) S 5,000
PERSONAL 6 AOV INJURY S 1,000,000
OENERALAGGREGATE s 3,000,000
GENLAOOREOATE UMMAPPUES PER PRODUCTS -COMPAIP AGG S 3,000,000
POLICY JPROECT lOE
AUTO iOBLLL LIABLTY
COMBINED SINGLE LIMIT
S 1,000,000
A AWAUTO NIA1816799 10/01/10 10/01/11 (Es'vo1 w)
ALLOWIEDAUTOS
BODI
Y INJURY
L i
X SCHeOULED AUTOS (Pr P-)
X HIRED AUTOS
BODILY INJURY
S
X NOWOMED AUTOS (Pa ddA^A)
PROPERTY DAMAGE
S
(PN &G*W
GARA06 LIABILITY ALTOONLY•EAACGDENT
S
ANY AUTO
OTHER THAN EA AG('
i
AUTO ONLY: AGO S
EXC[SSNMBRILLA LWBIIIT' EACH OCCURRENCE S
OCCUR ? CLAIMS MADE AOGREGATS, S
i
DEDUCTIBLE S
RETENTION 5 $
VWItIBRS CO?4WSATION AND V STATLL OM
TOR RY LILTS ER
EMPLOYERIF LIABILITY
ANY PROPRETORA'ARTNERrE%ECUTVE E.L EACH AMDENY $
OFFICEWENBER EXCLUDED?
E.L. DISEASE . EA EMPLOYEE
S
SPECML PROVISIONS blow E.L. DISEASE. POLICY LIMIT S
DTIRER
A Crime NIA1816799 10/01/10 10/01/11 Bldg 303,000
B Pro arty L13506 02/22/10 02/22/11
DESCRIPTION OF OPERATIONI ILOCATIONS I VEHIC UI 191CLUSIONS ADDED BY ENDORSEMENT I SPEC" PROV"M
*30 DAYS NOTICE OF CANCELLATION, EXCEPT 10 DAYS NOTICE OF CANCELLATION FOR
NON-PAYMENT OF PREMIUM. WORKERS COMPENSATION APPLIES TO FLORIDA OPERATIONS
ONLY. HOLDER IS ADDITIONAL INSURED LIABILITY FOR BLDG LOCATED 918 WOODLAWN
DR CLEARWATER, FL 33756 (OWNER OF BLDG) heather. latham@myclearwater.com
CERTIFICATE HOLDER CANCELLATION
CITY OF CLEARWATER
FAX #727-562-4037
ATTN: SHARON WALTON
PO BOX 4748
CLEARWATER FL 33758 4748
ACORD 26 (2001/08)
CITYCLR WOULD ANY OF THE ABOVE DESCRIBED POLIGEI Re CANCELLED BEFORE THE EXNBIATIOM
DATE THEREOF. THE ISMING INSURBRVAL ENDEAVOR TO MAL 30 DAYS WRITTEN
NOTICE TO THE OIRIIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO 1050 SHALL
W OM NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURM RX AGENTS OR
RNHWOTTATWM
ACARn C:nRPnRA7(nm 90RR
CASE (MMOOfM
FAACDRD.
EVIDENCE THAT INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS ALL THE
S IS
HTS AND PRIVILEGES AFFORDED UNDER THE POLICY.
PXO? . 727-376-0030 1727-376-2262P""Y
N4
Greg Roe Insurance, Inc. Underwriters at Lloyd's
9851 State Road 54
New Port Richey FL 34655
Alvina Davie A062355
Cpp? 6UG CODE
M
CUSTO
UeR or. FOUNVIL
usTO
INSURED LOAN NUMGER POLICY NUMBER
Foundation Village L13506
Neighborhood Family Ctr, Inc. EFFR INE DATE T EXPIRATION DATE .0- UEDUNTIL
918 Woodlawn St. 02/22/11 02/22/12 TERI IF CHECKED
Clearwater FL 33756-2157 TWO RMACE6 PRIOR EVIDENCE DATEDI
WICAiWWOESCRPRON
001
named insured provides tutoring for ch
918 Woodlawn St. ildren, holds meetings for communitych
Clearwater FL 33756 ildren (1,400sf occupied by polio
a substation-total of 5,040)
OOVERAGEMER0..11IlPORMi 7 AMOUNTOPWSUNANCE DEDucTIRLE
Premise 001 Building 001
BUILDING WIND/RAIL* 303000 2500
WIND/HAIL DED *5P6 TIV*
CP0125 6/95
THE POLICY IS SUBJECT TO THE PREMIUMS, FORMS, AND RULES IN EFFECT FOR EACH POLICY PERIOD. SHOULD THE
POLICY BE TERMINATED, THE COMPANY WILL GIVE THE ADDITIONAL INTEREST IDENTIFIED BELOW DAYS
WRITTEN NOTICE, AND WILL SEND NOTIFICATION OF ANY CHANGES TO THE POLICY THAT WOULD AFFECT THAT
INTEREST, IN ACCORDANCE WITH THE POLICY PROVISIONS OR AS REQUIRED BY LAW.
NAME AND ADDRESS MORTGAGEE X ADDITIONAL INSURED
L*$$ PAYEE
City of Clearwater Risk Mgr 7..
PO Box 47418 AUDwRIZEDREPREaerrArwe
Clearwater FL 33758 4748