CERTIFICATE OF LIABILITY INSURANCE
~~Rh^' [pERTIFICJ.\TEOFlIABILJTY INSURJ.\~CE ............. '/f Date (mm/dd/yy)
'.' ............ ............. 1/19/2006
Producer THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
WALLACE WELCH & WILLINGHAM INC THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
PO BOX 33020 COVERAGE AFFORDED BY THE POLICIES BELOW.
ST PETERSBURG, FL 33733 NAil #
INSURER American States Insurance Company 19704
A
INSURER
Insured B
PINELLAS COUNTY COALITION FOR INSURER
5180 62nd Ave N
Pinellas Park, FL 33781 C
INSURER
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....... ...,............
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.
POLICY POLICY
INSR ~DD EFFECTIVE EXPIRATION
lTR INSD TYPE OF INSURANCE POLICY NUMBER DATE MJJ~6fyv LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
A ./ Il =:]MMERCIAL GENERAL L1AB 01 CD35339240 11/1 0/2005 11/10/2006 DAMAGE TO RENTED PREMISES $
f- CLAIMS MADE[lJOCCUR MED EXP (Anv one oerson) $ U.UU(
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $ nnn 'lnr
GEN'L AGG LIMIT APPLIES PER PRODUCTS - COMP I OP AGG $
7lPOLlCY nPROJECTnLOC $
AUTOMOBilE LIABILITY COMBINED SINGLE LIMIT
_ ANY AUTO (Ea accident) $
_ ALL OWNED AUTOS BODILY INJURY
_ SCHEDULED AUTOS (Per person) $
_ HIRED AUTOS BODILY INJURY
_ NON-OWNED AUTOS (Per accident) $
PROPERTY DAMAGE
(Per accident) $
R~RAGE LIABILITY AUTO ONLY- EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
pcCESS LIABILITY EACH OCCURRENCE $
OCCUR DCLAIMS MADE AGGREGATE $
$
,. - . R~~PUCIlBLE - -- - '- " --' ->'-.->,,' '.. .- ' $ -- -~.,.. ....-
RETENTION $ $
WORKERS' COMPENSATION & Iwc Statutory Umit I I Other '...L. ........ .'
EMPLOYERS' LIABILITY EL EACH ACCIDENT $
~~MfR9~~W~~~m~'fMECUTIV EL DISEASE - EACH EMPLOYEE $
~~fAt"W8\'I~r8Ws below EL DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate Holder is an Additional Insured with written contract per form CG7635
CERTIFICATE HOLDER .' ..< "'CA,NCElLA TIOi\t'..ii"ii .. .... .......:...... ....
.... ...... ..... - ...... .' .............. . ':..i
I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEllED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY Will ENDEAVOR TO MAil
~DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
Ci~ of Clearwater lEFT, BUT FAilURE TO MAil SUCH NOTICE SHAll IMPOSE NO OBLIGATION
11 S Osceola Ave OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRE-
Clearwater, FL 33756 SENTATIVES.
AUTHORIZED
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ACORD 25 (2001/08)
IMPORT ANT
If the certificate holder is an ADDITIONAL INSURED, the poiicy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
- -JtSUBROGAIIONJS..WAlli.EQsubject .to.!he..terms..ancU:onditiClm-of.-the.f)Qlicy~~.may._
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.