CERTIFICATE OF LIABILITY INSURANCE
12/09/2005 15:46
727-441-3298
LANCASTER INS
PAGE 01/62
'If -
.
4....ACORQM CERTIFICAreOF LIABILITY INSURA_E I DATE (MM/DDfYYYYI
12/09/2005
PRODUCER. (727)461-3704 FAX (727)441-3298 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
IlanGaster Insurance Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1210 S. Myrtle Ave. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTl:R THE COVERAGE AFFORDED BY THE POLICIES BELOW.
POBox ~856
Clearwater, FL 33757 INSURERS AFFORDING COVERAGE NAIC#
INSUF\E;D Windsor Park HmOwners Assoc INSURER A: Auto Owners lS9S8
DBA: Jim Goins INSuAER B:
1726 Great Brikhill Rd INSURER c:
Clearwater, FL 33755 INSURER D:
INSURER E;
COVERAGES
THE; POLICIES OF INSURANCE LISTED BELOW HAVE; BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POl.lCY PE<RIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY pe;RTAIN, THE INSURANCE AFFORDED BY THE POLICIES DE:SCRIBeO HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
1~~Jl Ap,l61 TYpE OF INSURANCE POLICY NUMBER POUCY EFFECTIVE P!:!!;I,f"Y EXPIRATION LIMITS
GENERAL LIABILITY 20610817 01/15/2006 Ol/15/~007 EACH OCCURRENce $ SOO,OO(]
'--
X COMMEROIAL GENERAL LIABILITY DAMAGE TO RENT5D $ 50,OOfJ
I CLAIMS MADE !X] OCCUR MED Exp (Any ona palllon) $ 5,000
A PERSONAL & ADV INJURY S 500,OOC
-
GENERAL AGGREGATE $ SOO,OO
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COM~OPAGG $ 500,OO(
I 'nPRO- n
POLICY JECT LOC
~TOMOBJLE LIABILITY COMBINED SINGLE LIMIT S
ANY AuTO (Ea accident)
~
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Par paraon)
I---
HIRED AUTOS BODILY INJURY
I--- S
NON-OWNED AUTOS (Per ecddenl)
I---
PROPERTY DAMAGE S
(pQI' accident)
GARAGEi LI",BILlrr AUTO ONLY. Ell. ACCIDENT $
R ANY AUTO. OTHER THAN !;;AAce S
AUTO ONL V: AGG S
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
~ OCCUR 0 CLAIMS MADE . AGGREGATE: $
$
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I T~~.;rro;~s I IO~~-
EMPLOYERS' LIABiliTY
ANY PROPRIETORlPARTNER/EXECUTNE I;O.\.. eACH A,COIIJENT $
OFFICEf'l/MEMBER EXCLUDED? E.L. DIS~SE . EA EMPLOY5E $
If ~as. desctiba under
S ECIAl PROVISIONS below E.L DISEASE - POLICY LIMIT $
OTHER
.
DESCRIPTION OF OPERATIONS I lOCATIONS I VEHICLES I ~ClUSIONS fDED BY ENDORSEMENT I SPECIAL PROVISIONS
ert1f1cate holder is also an ad itiona insured subjec~ ~o ~he ~erms, conditions, and
~xclusions of the pOlicy.
C
City ofC1earwater
Department of Parks & Recreation
Attn: Kyle Kilian
POBox 4748
Clearwater, Fl 33758
SHOULD ANY OF THe AIIOve DSSCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. THE 188UINCilIN8URER WILL ENDEAVOR TO MAIL
~ DAYS WRITTIiN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE lEFT,
auT FAILURe TO MAIL SUCH NOTICE SHAI.L 'MPOS," NO OBLIGATION OR LIABILITY
OF PH'( KIND UPON THE INSUASA.1TS AGENTS OR REPRE;SgNTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD25(2001/08) FAX: 562-4825
@ACORDCORPORATlON 1988