CERTIFICATE OF LIABILITY INSURANCE (2)
~1/31/200G 12:31
727-441- 98'
LANCASTER INS
F't~GE 01/ EI~'
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I DJITI= (MMIDDIYr\ Y)
L Ol/n/20(l~;
R OF ,:NFORMATION
HE CEiUIFICATE
Mi:'.O EXTEND OR
!!f9.!.ICIIiS BELOW,_
NAIC#
M~QBQ CERTIFICATE OF LIABILITY INSURAN
PRODUCEF: (727)l
Lancaster In~
1210 S. JVi)'rt
P 0 110;( 21156
(1 eat'W;lter',
IN5URED-jt;rt1iaoy
nso Ho
Clearwa
1,61-1704 FAX (727)441-3298 THIS CERTIFICATE IS ISSUED AS A MATTE
,urance Inc. ONLY AND CONFERS NO RIGHTS UPON T
Ie Ave. HOLDER. THIS CERTIFICATE DOES NOT A
ALTER THE COVERAGE AFFORDED aY.Tti'
FL 33757 INSURERS AFFORDING COVERAGe
Bethany Educational program, Inc. INSURER A: Scottsdale
'It Ave ---
INSURl;:R a;
FL B755-3342 -_.-
.ter, Ii'JSUR!'R c:
--
INSURER 0:
_.
INSURER 10:
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c :&W:.
THE POUC1ES OF JNSURANCE LISTED BELOW HAV,," (;l~l<N ISSUl:<D TO THE INSURED NAMED ABOVE FOR THE POLICY P =RIOD I'IDIGATI::I). tJOTVJITHSTANDII~G
ANY ~E:aUIReMEtJT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS GERT!FI::ATE MAY E!E ISSUED OR
MAY F>f:f'<TAlt~, THE iNSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIOf'-5 ANtI CI)I~O!rlON$ 01= SUCH
POLlCIE~I, AClGRE(~ATE LIMITS SHOwN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
D' TY~JE OF INSURANCE POLICY NUMBER POUCY EFFECTIVE POLICY El(Pl~TION
GENERAlllllSlllTY CLS10921Z7 01/03/Z006 01/03/2007
Jj()OMM:;RClAl. G. !:~!:RAllIABllITV
.~. ] CLAIMS MADe [KJ OCCUR
_. - -
~;E;N'~ 1~c;GF:EGATE uNliT APF'LIES PER:
-, , P~O-
...J.!~~. JeCT LOC
wro"'IOBII.E LIAeIUTY
Ar1Y ALTO
A
L N1ns
EACH t)CCURF~;~CE ~===~$ 500~'. 00
DAr<~A~ ,E TO ~U:l !TEr., ~ 100 'I 00
~..Q.~WllJ:~.__._.___.~w..,..
MED E;:P (An)' <113 p6T!',cn:' ; $ 5 ,. 00
PERSC ~L & ;~:J IN~~~'-"".l~--~~.~~ 00
GE;J!,FA,LAG:;F~G!lT!: S 500,00
PRODLCTS-C~MPIO~~~~ $ 500.,-00
i
CO!ABI: lED SINGl.E LIMT
(Ea ace ~ent)
IIl..l OWNED AUTOS
8CHEC'ULED AUTOS
HI~EO AUTOS
IJON.O'NNED AUTOS
80DIL' INJURY
(Per pel aon)
1$
80')IL' INJURY
(Per ae< lelent)
1
!s
PROP!: ~TV D,~M :,G!:
(1'9Ia(>l~t)
GAR,AOIE LIN~IUTY
-.-fr~Y AUTO
EXCESSlUM ~RELl.A LfI\BII.ITY
-J ()OCUf< 0 CLAIMS MADE
AUTO('NLY'EI''''C(''O~~11 ':;
______-'_,'_'~,w""',_~___
OTH!:R THAN
AUTO ('Nl y,
.EA AGG I $
---.--.-----
AGG i $
EACH(~CURRENCE $
-.----.-
AoG~~GAtE ' $
-----------,
$
llI;DUCT!BLE
RETENTION $
WOi~KE'RS (;OMP[NSATION AND
eMPLOYERS' UAEdllTY
ANY P~:OPRI~TOF:IPARTNERlEXECl 'TIVE
OFFIC~I'\IM!;MeEF< EXCLUOED?
If yes., ~~~riIJ" und""
SPECI~L PROVISIONS b9k1w
OTtlER
$
1 w ~i~J.IJ3m:.,---~
fr:LUMI.I.:, .J:fL_
E.L ep. ~H ACCI~'=Nl
E.l_ Olf EASE - E ~ E~IPl.O"EE' $
E,L.. Olf EAS!' . P:>LICY I.It,11T ":
-....-.----.----
OE5CRIPTJ('~1 OF "PER/ITIONS / LOCATIOtIS/ VEHICLES I eXCLUSIONS ADDED IlY ENDORSEMENT / SP'ECIAL PROV~IONS. b' .
'ert1f1cate HOlder is an Additional Insured as respects (jeneral L 1a 11ny subject to tIlE! te!l"'IlIS,
-ondit;()ns, and excl US;I)ns of the policy.
~1QmJ:I.Q~pER
City of C1 earwater
Ol!par'tmlmt of Parks &I Recreation
Aun: Kilthy Laterza
p 0 E~ox 4748
Clear'water, FL 33758
SHOULD ANY OF THE ABOVE DESCRIBED P JlICIE5 HE CaNCEl.lI:!) 8EFORE THE
EXPIRATION DAn; THERIOOf', THE 1lil1ilU'~G ~lIi1UF\EI~ WILl. ENaE~,VDFl to MAIL
~ DAYS ~ITTEN NOTICE TO THE CE mFICAT:: H(U'E:~ N.'hIED TO mE: lEFT,
BUT FAILURE TO MAIl.. $UCH NOTICE SHALI..IMPOS';; NO rJBL1I3,mON UF: liABILITY
OF /Ii('( KIND UPON THE IN$URER, ITS AGE;NTS OR REPR=S~~~WE~,.
AUTHORIZED REPRE5EHTATI'/E
~ ~~ ---
@ACmm CORPORATION 1988
ACORt. 2'5 (20011f.l8) FAX: 793-2328
I q. l 3 -. 0 0