CERTIFICATE OF LIABILITY INSURANCE (18)rliprif#• Rd7S7
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ACORDTM CERTIFICATE OF LIABILITY INSURANCE D
IDD/YYYY)
4
/04/2
4/04/2011
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. 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).
PRODUCER CONTACT
NAME:
Willis of Pennsylvania, Inc. PH°NE 610 260300 A/C No610-260-43117
A/C No Ell :
100 Matsonford Road E-UAIL
ADDRESS:
m W
Bldg. 5 Suite 20O
INSURER(S) AFFORDING COVERAGE NAIL #
Radnor, PA 19087 INSURER A; Philadelphia Insurance Company 18058
INSURED INSURER B: Gemini Insurance Company 10833
Global Spectrum, LP
INSURER C :
3601 South Broad Street
INSURER D:
Philadelphia, PA 19148
INSURER E :
CERTIFICATE NUMBER:
REVISION NUMBER:
THIS IS TO CERTIFY THAT 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 CONTRACTOR 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE ADDL
IN R SUBR
WVD
POLICY NUMBER POLICY EFF
(MIm YYYY POLICY EXP
MM/DD/YYYY
LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISES Ea occurrence)
$
CLAIMS-MADE 7 OCCUR MED EXP (Any one person) $
_._..._?......"...._.,........?._?. .,? ,_ PERSONAL 8 ADV INJURY $
GENERAL AGGREGATE .
$
GFN'L AGGREGATE LIMIT APPLIES PER:
- PRODUCTS - COMP/OP AGG $
POLICY PRO-
1 LOC
JECT 1
$
A AUT OMOBILE LIABILITY
PHPKIS37751
ECE
10/18111 COMBINED SINGLE LIMFT "Wu
'"accident)
$1,000,000
X ANY AUTO P
L`-II ?e ?F __
BODILY INJURY (Per person) $
ALL OWNED SCHEDULED
BODILY INJURY (Per accident)
$
AUTOS AUTOS
HIREDAUTOS
NON-OWNED
AUTOS
^
'T ?) Sy
I
4.11
PROPERTY DAMAGE
Per ecsident
$
$
UMBRELLA LIAR
H OCCUR ?
n
,
??
?
F EACH OCCURRENCE $
EXCESS LIAB y
y
y
CLAIMS-MADE
.
! ®
C
AGGREGATE
$
DED RETENTION $ ?
IRGI c nvE av c
C $
WORKERS COMPENSATION WC STATU-
OTH-
AND EMPLOYERS' LIABILITY TORY
Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
E
L
EACH ACCIDENT
$
DFFIr: _R/MFM9GR FXCL ' _?.? .?.._ .. .
.
?.
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below F-L- DISEASE -POLICY LIMIT $
B Pesslonal VPPLOO4404 04101/2011 04/01/201 $3,000,000 Limit
Liability $5,000 Deductible
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
RE: Harbvrview Center, 300 Cleveland Street, Clearwater, FL 33755
City of Clearwater is included as Additional Insured solely with respect
to the operations of the Named Insured for Auto Liability as required by
signed contract.
ANY OF
City of Clearwater THE SHOULD EXPI
RA IONH DATE ABOVE THEREOF, DESCRIBED NOT CEIEWIBLL CBE CDEL VEREDO NE
112 S. Osceola Avenue ACCORDANCE WrrH THE POLICY PROVISIONS.
Clearwater, FL 34618
AUTHORIZED REPRESENTATIVE
01988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S579888/M579875 1 TNYB