Loading...
CERTIFICATE OF LIABILITY INSURANCE ACORD.. CERTIFICATE OF LIABILITY INSURANCE OP ID D9 DATE (MM/DDNYVY) UPARC-1 12/12/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Bouchard-Clearwater ONLY AND CONFERS NO RIGHTSUPON THE CERTIFICATE 101 Starcrest Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR POBox 6090 ALTER THE COVERAGE AFFORDED BY THE POLCIES BELOW. Clearwater FL 33758-6090 Phone: 727-447-6481 Fax: 727-449-1267 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Bridgefield Casual ty Ins CO INSURER B: Everest National Insurance Co 10120 UPARC Inc INSURER c: James River Insurance Co 12203 1501 North Belcher Road INSURER 0: Clearwater FL 33765-1302 INSURER E: COVERAGES 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. LTR NSRI TYPE OF INSURANCE POLICY NUMBER DATE MM/DQI!!l DATE IMM/DOiYYj' LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 - 12/01/05 12/01/06 PREMiSES TE'~'O'~u~~nce) $ 100000 B X X COMMERCIAL GENERAL LIABILITY TBD I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5000 10 DAY CANe FOR NONPAY PERSONAL & ADV INJURY $ 1000000 - GENERAL AGGREGATE $ 2000000 r- $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COM PlOP AGG n n PRO- nLOC Emp Ben. 1000000 POLICY JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 r- 12/01/05 12/01/06 (Ea accident) B X ANY AUTO CAOOOOO137041 t-- ALL OWNED AUTOS BODILY INJURY r- (Per person) $ SCHEDULED AUTOS r-- X HIRED AUTOS BODILY INJURY t---- (Per accident) $ X NON-OWNED AUTOS r-- X 10 OAY CANe FOR NONPAY PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ =1 ANY AUTO OTHER THAN EA ACC $ . AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 1000000 C ~ OCCUR D CLAIMS MADE 00013102 12/01/05 12/01/06 AGGREGATE $ 1000000 10 Day $ ~ DEDUCTIBLE Canc for $ X RETENTION $0 Nonpay $ WORKERS COMPENSATION AND X I TORY LIMITS I IUJ~- A EMPLOYERS' LIABILITY 019603019 04/01/05 04/01/06 E.L. EACH ACCIDENT $ 1000000 ANY PROPRIETORlPARTNERlEXECUTIVE -- OFEICEBlMEMRFR EXClIIOFn? -~-- [-1.0 I!AT'ooo;-FOR NOIIPAY" " ".----- -- "---- "'EI.. UTSEJ\SF= CA EMPLOYEE T1OUOUOU ~~~MtS~~~v'j~~~~s below E.L. DISEASE - POLICY LIMIT $ 1000000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER IS NAMED ADDITIONAL INSURED WITH RESPECTS TO GENERAL LIABILITY SUBJECT TO ALL TERMS, CONDITIONS AND EXCLUSIONS OF THE POLICY. FAXED TO: 727-562-4825 ATTN: DEBBIE CERTIFICATE HOLDER XCITYOF CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATlO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESE AUTHOR CITY OF CLEARWATER PARKS AND RECREATION DEPT 100 S MYRTLE AVE CLEARWATER FL 33756-5520 ACORD 25 (2001/08) @ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISGLAIMER-- .. -------~-...-._. - ...-..- ........... . 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. RECEIVED i':(> 1 13 2005 .....,_....v OFFICIAL RECORDS AND LEGISLATIVE SRVCS DEPT ACORD 25 (2001/08)