CERTIFICATE OF LIABILITY INSURANCE (3) ACORD,, CERTIFICATE OF LIABILITY INSURANCE D A T E(M M to D rNrYfYY)
02/13/2012
THIS CERTIFICATE 15 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 INSURERS) AUTHOR12ED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER-
(ies)must be endorsed- If SUBROGATION IS WAIVED,subject tc,
the terms and conditions of the poky,certaim policies may require an eridorsement. A statement on,this Certificate does not confer rights to the
cartificate holder in lieu of such candorserneril(s),
PRODUCER
Alley, Rehbaum & Capes Assurance, Inc, kf
, HON
N o 7 2 7.7 9 7.5 19 3 FAX 727.725.5773
2433 Gulf to Bay Blvd. E•VAIL .... ...........
ADDRESS.
P.O. Box 4620 r Rau
CUSTOMER ID#, 00017244
Clearwater, FL 3375 ..........
INSURERS)AFFORCTtrd GCOVERAGE NAIC
INSURE'D )INSURER A; Philadelphia Tindemnity Ins Co i
Life Force Cultural Arts Academy, Inc. -INSURER 8: ------------------------------
1606 N. Highland Ave INSURER C
Clearwater, FL 33755 INSURER D
INSIrRER E -------
COVERAGES CERTIFICATE NUMBER, 11-12 Current REVISION NUMBER:
THIS ISTOCERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE,INSURED NAMED ABOVE FOR THE POLICY PERIO6
INDICATED, NOI'AIT[ISTANDING ANYRECIUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT IOVVIHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERVIS-
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMIT'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAdMS,
il �T—NSFi "BAT
I PO
TYPE OF ON&VAANCs Illy n LIMITS
LTR QSR VVVU FIOUCY NUMBER MMIU0111(yyy MMI[Juhryyy
—---------
GENERAL.LIABILITY
PHPK764680 1010112011 10101 92012 F&CH OCCURRENCE $ 1,000,00
X C',QMMERCIAL.GFNERALLIABII-[TY -DAM
000�010
60
-io�
1 100,00
MED FXP{Any we person) S 5,00
CLAIM9-MADE VI OCCUR
A
FIE RSONAL&ADV RUI-IRY 1,000 00
A
GENCkAL A,36REGAT S L000- 00
r,EN'LAOGREGATE LIMIT APPUES PER PRODUCTS-COMNOP AGG $ 3,.0 00
Ts
OLICY JET-'Y- W.
OBILE LIABILITY 70MISINED ZINGI_F;_Wt T $
(Ea acud6ni)
A114Y AU"O
AUTOil
SONLY INJIURY(Per person) Is
BODILY �
INJURY(Per ac 1,%
SCHEDULED AUTOS ------
P ROPE RTY F-IAMAGE
HIRED AUTOS Ipe,&cc:denn
NON-OWNED AUTOS
Occur EACH QCCQRRENCZ
UMBRELLA UA
EXCESS LtAB CLAIMS-MADEi E AGGREGATE
DEDUCTIBLE
RFTE,N
TICIP $
WORKERS COMPENSATION WC STATU- OT H
AND EMPLOYERS LIABILITY Y t N i0py LIMITS _ER
ANY PROPRLF TQ C
RPARTNF_R/V XV UTI 1L E.L.EACH ACCIDENT T�L
OFRCERrMEMBEA EXCLUDED" N i A
Mandatory in NH) LDISEASE-EA E M PLOY E E
If yes,descnbe under _ __
DESCRIPTION OF OPERATIONS bduw i E. 01 SEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS f LOCATIONS fVEHiCLES
-
ertificate Holder is Additional Insurance
_Etc ation.� 1751 Kings Highway, Clearwater, FL 33755
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE A84OVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROASIONS,
City of Clearwater AUrHORWED REPRESENTATIVE
100 S. Myrtle Avenue
Clearwater, FIL 33756 j�s_h_ature on Filel
@ 1988-2009 ACC RD CORPORATION. AN rights reserved.
ACORD 26(2009109) The ACORD name and logo are registered inarks of ACORD