CERTIFICATE OF LIABILITY INSURANCE (12)COMMU-1 OP ID: NP
CERTIFICATE OF LIABILITY INSURANCE YY)
11ATE
06/22/11
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(ies) 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
727-797-0441 CONTACT
NAME:
Connelly, Carlisle, Fields &
727
669
0673 PHONE '?-' FAX
-
-
Nichols arc Nc EXt : A!c No :
P.O. Box 1027 E-MAIL
ADDRESS:
Clearwater, FL 33757
John R. Fields INSURERS AFFORDING COVERAGE NAIC #
- INSURER A: Cincinnati Specialty Und.
INSURED Community Pride Child Care INSURER B:SUmmitConsulting,
Inc.
Center of Clearwater, Inc. _
W
1235 H
lt A INSURER C :
o
ve.
Clearwater
FL 33755-3310 INSURER D :
,
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
4CR I11-H-m I r
City of Clearwater
Real Estate Services Manager
Mr. Earl Barrett
P.O. Box 4748
CITYC-1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
.
THIS IS TO CERTIFY. THATTHE POLICIES -QF_IN5URANGE- LIS.TED.,5EL0\1%L HAVE=BEEN ISSUED T-Q-T44E I-NSURGD-NAME-ABOVE FOR THE POLICY-PERIOD
INDICA
Ebb,-NUT-\-MTHSTANDING 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE D
POLICY NUMBER POLICY E
MM/DD/YYYY -611- lik!
MM/DD/YYYY
"--
LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00
A X COMMERCIAL GENERAL LIABILITY X CS00029134 06/30/11 06130112 PREMISES Ea occurrence $ 100,00
x
CLAIMS-MADE F
IOCCUR MED EXP (Any one person) $ 5,00
PERSONAL & ADV INJURY $ 1,000,00
GENERAL AGGREGATE $ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER -,, rr• l'"".? „ , J PRODUCTS - COMP/OP AGG $ 2,000,00
X POLICY PRO- LOC F ++ _W $
AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident 1,000,000
$
A ANY AUTO CS00029134 06/ /
10
!30112
BODILY INJURY (Per person)
$
ALL OWNED
AUTOS SCHEDULED
AUTOS BODILY INJURY (Per accident) $
X HIRED AUTOS X NON-OWNED
AUTOS PROPERTY DAMAGE
Per accident $ '
--
R
I
m, _
.
' $
UMBRELLA LIAB
OCCUR
,.,•.1 ?r
?i???'i'.1
EACH OCCURRENCE
$
EXCE33LIA8 CLAIMS-MADE
AGGREG AGGREGATE R.-
$
pE0 RETENTION $ $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY XQR LIMITS I ~
B Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? F-]
N / A 52040460 04/01/11 04/01/12 E.L. EACH ACCIDENT ^ 100,00
$
(Mandatory In NH) --
E.L. DISEASE - EA EMPLOYEE
$ 100,00
If yes, describe under
DESCRIPTION OF OPERATIONS below
nic
^
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
IN
tU
Locations: 1235 Holt Ave., Clearwater, FL 33755 and
RECE
I
211 S. Missouri Ave„ Clearwater,FL 33756
Certificate Holder is listed as a Additional Insured with respect to the
above listed G
n
JUN 2 7 2011
l Li
bilit
e
era
a
y.
CX-FICIv- RECOPOS AN
ST VCS DEPT
U 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD