CERTIFICATE OF INSURANCE (2)
ACORD.
CERTIFICATE OF LIABILITY INSURANC~~6~~ T DA~E~=3
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
Wallace Welch & Willingham Inc
300 First Avenue South, 5th Fl
P.O. Box 33020
St. Petersburg FL 33733
Phone: 727-522-7777 Fax: 727-521-2902
INSURERS AFFORDING COVERAGE
Personal Enrichment Through
Mental Health SevicesL Inc.
11254 58th Street Nor~h
Pinellas Park FL 33782
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
Lexin ton Insurance Com an
Florida Retail Federation
United States Fire Ins Co.
National Indemnit Co
INSURED
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~f: TYPE OF INSURANCE POLICY NUMBER DATEjM.w~ -Wl-+~~MIDD1YYI" LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
-
A X COMMERCIAL GENERAL LIABILITY 6792340 10/01/03 10/01/04 FIRE DAMAGE (Anyone fire) $ 50,000
X ! CLAIMS MADE 0 OCCUR MED E..'<P (,..~y one porsen) $10,000
- PERSONAL & ADV INJURY $ 1,000,000
- GENERAL AGGREGATE $2,000,000
~'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
. n PRO- ril
POLICY JECT X LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $1,000,000
D ANY AUTO 74APN244114 10/01/03 10/01/04 (Ea accident)
-
i-- ALL OWNED AUTOS BODILY INJURY
$
X SCHEDULED AUTOS (Per parson)
i--
~ HIRED AUTOS BODILY INJURY
(Per aa:ldent) $
~ NON-oWNED AUTOS
PROPERTY DAMAGE $
(Per aa:ident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
tJ OCCUR o CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X I TORY LIMITS I IO~~-
B EMPLOYERS' LIABILITY 52028658 07/01/03 07/01/04 $ 500,000
E.L. EACH ACCIDENT
E.L. DISEASE. EA EMPLOYEE $ 500,000
E.L. DISEASE - POLICY LIMIT $ 500.000
OTHER
A Professional Liab 6792340 10/01/03 10/01/04 Ea Incdnt 1,000,000
Ann Aaa 2 000,000
DESCRIPTION OF OPERATIONSlLOCATlONSNEHlCLESlEXCLUSIONS ADDED BY ENDORSEMENTISPEClAL PROVISIONS
CERTIFICATE HOLDER I N T ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
CICLEAR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAlL ..1.0....- DAYS WRITTEN
City Hall NOTICE 10 THE CERTlRCATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Attn: Earl Jones IMPOSE NO OBUGATlON OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
112 S Osceola Avenue
Clearwater FL 33756 REPRESENTATIVES.
I A~~~.
ACORD 25-5 7 /
(7/9 )
@ACORDCORPORATION1988