EVIDENCE OF PROPERTY INSURANCE
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.. THIS IS EVIDENCE THAT INSURANCE-AS IDENTIFIED BELOW HAS BEEN ISSUED,.IS IN FORCE, AND CONVEYS ALL THE
RIG HTS AND PRIVILEG ES AFFORDED UNDER THE POLICY
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PRODUCER iAil': No~ Exll: 727-796-6666 COMPANY
Acordia Southeast, Inc FI REMAN , S FUN D I NSU RANCE CO
PO Box 3 1 666 P 0 BOX 1 1 605 5
Tampa, FL 3363 1 -3666 A TLANT A, GA 30368-6055
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CODE: 09-1 031 50 I SUB CODE:
~3~~gLER 10 ,: PER54440
INSURED LOAN NUMBER I POUCY NUMBER
PACT, Inc , Performing Arts Mzxa0769590 1
Center Foundation, I nc EFFECTIVE DATE I EXPIRATION DATE In
1 1 1 1 McMullen Booth Road 1 0/01 /00 1 0/01 /01 CONTINUED UNTIL
TERMINATED IF CHECKED
Clearwater FL 33759- THIS REPLACES PRIOR EVIDENCE DATED:
I 1 /1 7/01
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LOCATION/DESCRIPTION
1 1 1 1 MCMULLEN BOOTH RD
CLEARWATER FL 3461 9
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COVERAGE/PERILS/FORMS AMOUNT OF INSURANCE DEDUCTIBLE
BUILDING 16584 5 94 5 000
BUILDING 'WIND & HAIL DEDUCTIBLE 1 %
CONTENTS 1 8 32 8 3 7 5000
CONTENTS WIND & HAIL DEDUCTIBLE 1 %
BUSINESS INCOME 1626000
SPECIAL FORM
REPLACEMENT COST
AGREED AMOUNT
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CITY IS FUNDING CONSTRUCTION OF EDUCATION WING
REQUIRING PROOF OF INSURANCE.
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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 30 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 REQU IRED BY LAW.
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NAME AND ADDRESS MORTGAGEE AOOITIONAL INSURED
CITY OF CLEARWATER LOSS PAYEE .----.-"--.---.-..--.,----
ATTN : PARKS & RECREATION LOAN ,
1 00 S MYRTLE AVE .IDEBBI E REI D
CLEARWATER FL 33756 AUTHORIZED REPRESENTATIVE,
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ACORDTM
CERTIFICAT - OF LIABILITY INSURA
DAlE IMM/UDIYYI
1/17/01
THIS CERTIFICATE I 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.
CE
PR\:lDUCER
ACORDIA EAST - TAMPA BAY
P.O, Box 31666
Tampa, FL 33631-3666
727-796-6666
INSURED
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
INSURERS AFFORDING COVERAGE
GULF INSURANCE COMPANY
FIREMAN'S FUND INSURANCE CO
Zenith Insurance Co-DB
PACT, Inc., Performing Arts
Center Foundation, Inc.
1111 McMullen Booth Road
Clearwater FL 33759
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.
II~:~ ~9.~Y EFFECTIVE POLICY EXPIRATION --.-.--
TYPE OF INSURANCE POLICY NUMBER LIMITS
A ~ERAL LIABILITY CGL0458719 10/01/00 10/01/01 EACH OCCURRENCE $ 100_~()QQ_
----,---- --.-.-,. h__
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fi,el $ .~.O~.o_iL
I CLAIMS MADE W OCCUR ---"..- '--
MED EXP IAny one personl $ 5000
- PERSONAL & ADV INJURY $ .__!.Q.OOOOO _
- GENERAL AGGREGATE . 2000000
~'L AGGREn LIMIT APri PER: PRODUCTS. COMP/OP AGG $ 2000000
X POLICY P,~,QT LOC
A ~OMOBILE LIABILITY BA5737393 10/01/00 10/01/01 COMBINED SINGLE LIMIT
(Ea accident) $ 1000000
~ ANY AUTO
~ ALL OWNED AUTOS BODILY INJURY
$
--'i. SCHEDULED AUTOS {Per personl
--'i. HIRED AUTOS BODILY INJURY
$
--'i. NON-OWNED AUTOS (Per accident)
- PROPERTY DAMAGE $
(Per accident)
~RAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
B EXCESS LIABILITY XYZ75156711 10/01/00 10/01/01 EACH OCCURRENCE $ 10000000
tiloCCUR 0 CLAIMS MADE AGGREGATE $ 10000000
$
R DEDUCTIBLE $
RETENTION $ $
C WORKERS COMPENSATION AND 60942 1/01/00 1/01/01 X I ~~:I~Vs r TOlJi-
EMPLOYERS' LIABILITY E,L, EACH ACCIDENT $
1000000
.
E,L. DISEASE - EA EMPLOYEE $ 1000000
E,L. DISEASE. POLICY LIMIT $ 1000000
OTHER
.
DESCRIPTION OF OPERATIONSIlOCATlONSNEHICLESIEXCLUSlONS ADDED BY ENDORSEMENTISPECIAl PROVISIONS
CITY IS FUNDING CONSTRUCTION OF EDUCATION WING
REQUIRING PROOF OF INSURANCE.
CERTIFICATE HOLDER I I ADDITIONAL INSURED: INSURER lETTER: CANCELLATION
SHOULD ANY OF THE ABOVE OESCRlBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF CLEARWATER DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
ATTN: PARKS & RECREATION NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO 00 SO SHALL
100 S. MYRTLE AVE./DEBBIE REID IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON TIlE INSURER. ITS AGENTS OR
CLEARWATER FL 33756 REPRESENoTATIVES. )
AUTH A1/(~
I '-""W -_ ',r
ACORD 25-S (7/97)
7- 90
@ACORD CORPORATION 1988
;
)
I
, ,IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(iesl must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement/s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer/s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
.,
ACORD 25-S (7/97)