CERTIFICATE OF INSURANCE (3)
~_CQRI)N
CERTIFICATE OF LIABILITY INSURANCE
OP ID P
PERSO-3 10/05/04
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.
DATE (MM/DDIYYYY)
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
NAIC#
INSURED
Personal Enrichment Through
Mental Health Sevices, Inc.
11254 58th Street North
pinellas Park FL 33782
INSURER A:
INSURER B:
INSURER C
INSURER D:
INSURER E:
Lexington Insurance Company
Florida Retail Federation
United States Fire Ins Co.
National Indemnity Company
Travelers Insurance Company
21113
42137
19070
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.
LTR NSRD TYPE OF INSURANCE POLICY NUMBER ~q,;!~1~EFFEs:.n~E PQ~ICY(~XPIRA1~N LIMITS
DATE MMIODIYY DATE MMIODIYY
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
- UAMA\jt: '''' '"
A X COMMERCIAL GENERAL LIABILITY PFP6000209201 10/01/04 10/01/05 PREMISES (Ea occurence) $50,000
-- --- --- X I CLAIMS MADE D O_CCUR ---- --- - -- MEDEXP (Any one!)erson) $ 5_, 000
PERSONAL & ADV INJURY $1,000,000
-
GENERAL AGGREGATE $3,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG $ 1,000,000
I n PRO- !Xl LOC Empl Ben 1,000,000
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $ 1,000,000
D ANY AUTO 74APN264460 10/01/04 10/01/05 (Ea accident)
-
ALL OWNED AUTOS BODILY INJURY
- $
X SCHEDULED AUTOS (Per person)
-
X HIRED AUTOS BODILY INJURY
- $
X NON-OWNED AUTOS (Per.accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY I EACH OCCURRENCE $
::::J OCCUR D CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND lWC-STATU- I IU~~-
X TORY LIMITS
B EMPLOYERS' LIABILITY 52028658 07/01/04 07/01/05 $ 500, 000
ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT
---- OFFICEFVMIOMBEREXCLlJOm'?~---- --- - --- -- --------- ------_.,------,---- -------~--- -- ~--~- - -- M __,_.__ __'__ __ __, $5()0;OOO
E.L. DISEASE. EA EMPLOYEE
If yes, describe under E.L. DISEASE - POLICY LIMIT $ 500,000
SPECIAL PROVISIONS below
OTHER
A Professional Liab PFP6000209201 10/01/04 10/01/05 Ea Incdnt 1,000,000
$25000 Dad Ann Agg 2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDEO BY ENDORSEMENT / SPECIAL PROVISIONS
'04 OCT 6 PM1:22
City of Clearwater
City Hall
Attn: Earl Jones
112 S Osceola Avenue
Clearwater FL 33756
CANCELLATION
CICLEAR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINO UPON THE INSURER, ITS AGENTS OR
CERTIFICATE HOLDER
ACORD 25 (2001/08)
@ACORD CORPORATION 1988