CERTIFICATE OF LIABILITY INSURANCE
ACORD.
CERTIFICATE OF LIABILITY INSURANCE
OP ID P DATE (MMlDDIYYYY)
PINE-13 10 08 04
THIS CERTIFICATE IS ISSUED AS A MAnER 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
Brown & Brown Insurance
17757 US Highway 19 N, Ste 660
P.o. Box 2456
Clearwater FL 33757-2456
Phone: 727-461-6044 Fax:727-442-7695
INSURED
INSURERS AFFORDING COVERAGE
Pinellas Opportunity Council,
Inc.
3443 1st Avenue North
St Petersburg FL 33713
COVERAGES
INSURER A:
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
Philadel hia Insurance Co.
AmeriTrust Insurance Corp.
NAlC#
23850
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.
NSRC POLICY NUMBER POL.K;y EFFECTIVE I POL.K;Y ~~N LIMITS
LTR TYPE OF INSURANCE DATE DATEIMM/Q
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
f--
A r-!- COMMERCIAl GENERAL LIABILITY PHPK095576 09/30/04 09/30/05 ~~~s tea oce.;-rence) $100,000
f-- =:J CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5,000
PERSONAL & AOV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COM~OPAGG $2,000,000
Xl POLlCyn ~~8i n LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $1,000,000
A ANY AUTO PHPK095576 09/30/04 09/30/05 (Ea accident)
-
- ALL OWNED AUTOS BODILY INJURY
(Per person) $
..!... SCHEDULED AUTOS
X HIRED AUTOS BODILY INJURY
- $
..!... NON-OWNED AUTOS (Per accident)
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
tJ OCCUR o CLAIMS MADE AGGREGATE $
S
q DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X IT~~Y:;~I~Ws I IO~-
IB EMPLOYERS' LIABILITY 1002-03212-00 09/30/04 09/30/05 $100,000
ANY PROPRlETORIPARTNERlEXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E.L. DISEASE. EA EMPLOYEE $100,000
If ~es, describe under E.L. DISEASE - POLICY LIMIT $500,000
S ECIAL PROVISIONS below
OTHER
A Professional Lia PHPK095576 09/30/04 09/30/05 Each Occu 1,000,000
A Crime PHPK095576 09/30/04 09/30/05 E:mI) Dish 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
l04 OCT 12 PM12:5t
CERTIFICATE HOLDER CANCELLATION
CITYOFC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAlL !L DAYS WRITTEN
NOnCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON. THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
City of Clearwater
Community Deve Block Grant prg
112 So Osceola Ave
Clearwater FL 33756
T~~~
ACORD 25 (2001/08)
@ACORD CORPORATION 1988