CERTIFICATE OF LIABILITY INSURANCE 14795
CERTIFICATE OF LIABILITY INSURANCE DATE 9/199/19/200111 1
/2
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 CONTACT Kris Thompson
Commercial Lines-(813)639-3000
B N Ext:ON 813.639.3058 aC,No:
813.639.7192
Wells Fargo Insurance Services USA, Inc. (A MAIL
2502 N. Rocky Point Drive,Suite 400 ADDRESS: kris.thompson @wellsfargo.com
INSURER(S)AFFORDING COVERAGE NAIC#
Tampa, FL 33607 INSURERA: American Zurich Insurance Company 40142
INSURED Ruth Eckerd Hall, Inc. INSURER B: Florida Hospitality Mutual Ins Co 10699
1111 McMullen Booth Road INSURER C:
INSURER D
INSURER E:
Clearwater, FL 33759
INSURER F
COVERAGES CERTIFICATE NUMBER: 3260493 REVISION NUMBER: See below
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 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
A GENERAL LIABILITY CP0278060506 05/31/2011 05/31/2012 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE PREMISES S( RENTED 100,000
Ea occurrence $
CLAIMS-MADE OCCUR MED EXP(Any one person) $ 10,000
PERSONAL&ADV INJURY $ 11000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000
POLICY PRO
JE X LOC $
CT
• AUTOMOBILE LIABILITY CP0278060506 05/31/2011 05/31/2012 COMBINED SINGLE LIMIT 1,000,000
Ea accident $
X ANY AUTO BODILY INJURY(Per person) $
ALLOWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE
X HIRED AUTOS X AUTOS Per accident) $
• UMBRELLA LAB X OCCUR UMB967294101 05/31/2011 05/31/2012 EACH OCCURRENCE $ 10,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000
DED X RETENTION$ 0 $
WORKERS COMPENSATION X WC STATU- OTH-
B AND EMPLOYERS'LIABILITY Y/N WC306-0020798-2010 1/1/2011 1/1/2012 TORY LIMITS ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? ❑ NIA
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
[Certificate Holder]is Additional Insured per written contract with respects to General Liability. Location 405 Cleveland St., Clearwater, FL 442-6152.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Attn: Christopher Hubbard ACCORDANCE WITH THE POLICY PROVISIONS.
Parks&Recreation Department
AUTHORIZED REPRESENTATIVE
100 S. Myrtle Avenue
e
Clearwater, FL 33756-5520
The ACORD name and logo are registered marks of ACORD @ 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105)
(This certificate replaces certificate#3260490 issued on 9/19/2011)