CERTIFICATE OF LIABILITY INSURANCE (3)
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE IMM/DDIYYI
02128/06
PRODUCER THIS CERTIFICATE IS ISSUED AS A MA ITER OF INFORMATION
Acordia Southeast, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 31666 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tampa, FL 33631-3666
727-796-6666 INSURERS AFFORDING COVERAGE
INSURED Clearwater Historical INSURER A: AMERICAN STATES INS CO-09084
Society INSURER B:
P. O. Box 175 INSURER C:
,Clearwater FL 33757-0175 INSURER 0:
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.
I~SR TYPE OF INSURANCE POLICY NUMBER h<i~~YJ~~g"R."~ Pgk!fEYr~~:~J.:~N LIMITS
TR
A GENERAL LIABILITY 01 CGl164935 1/20106 1/20107 EACH OCCURRENCE $ 5.00000
-
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ 200000
I CLAIMS MADE W OCCUR MED EXP (Anyone person) $ 10000
PERSONAL & ADV INJURY $ 500000
GENERAL AGGREGATE $ 500000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG $ 500000
I POLICY h P~,Q.;. n LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea eccidentl
-
- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
-
- HIRED AUTOS BODILY INJURY
$
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCID.ENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND WC STATU', I 10TH.
TORY LIMITS ER
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT ... $ ... .c.
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE. POLICY LIMIT $
OTHER
..
'r, "
".)
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS /; ii
CERTIFICA TE HOLDER IS NAMED AS AN ADDITIONAL INSURED WITH RESPECT l
TO GENERAL LIABILITY. /L
......i
, ,1
CERTIFICATE HOLDER I X I ADDITIONAL INSURED; INSURER lETTER: CANCELLATION
CITY OF CLEARWATER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCelLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL --1Q.. DAYS WRITTEN
PARKS AND RECREATION DEPT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
100 S MYRTLE AVE IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
CLEARWATER, FL 33756 REPRESENT ATIV~" .... J /
AUTHORIZ6I1'REPRESZ TA:U ~.A J iJ
I
ACORD 25-S (7/97) - _r ~ L,r-, J1i
45 38
@ACORD CORPORATION 1988
THIS IS EVIDENCE THAT INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS ALL THE
RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY.
PRODUCER PHgN~ 727-796-6666
Acordia Southeast, Inc.
PO Box 31666
Tampa, FL 33631-3666
COMPANY
AMERICAN STATES INS CO-09084
POBOX 34691
SEATTLE, WA 98124-1691
CODE: 09-031317
~3~~g~ERID#' CLE31731
INSURED
SUB CODE:
THIS REPLACES PRIOR EVIDENCE DATED:
2/28/06
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LOCATION/DESCRIPTION
1350 S GREENWOOD AVE
CLEARWATER. FL 33756
Clearwater Historical
Society
P. O. Box 175
Clearwater FL 33757-0175
EFFECTIVE DATE
1/20/06
EXPIRATION DATE
1/20/07
CONTINUED UNTIL
TERMINATED IF CHECKED
LOAN NUMBER
POLICY NUMBER
01CG1164935 01
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COVERAGEIPERILS/FORMS
AMOUNT OF INSURANCE
DEDUCTIBLE
BUILDING
CONTENTS
SPECIAL FORM
REPLACEMENT COST
148200
11670
250
250
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CERTIFICA TE HOLDER IS NAMED AS AN ADDITIONAL INSURED WITH RESPECT
TO GENERAL LIABILITY.
I
I'
: I~ d
THE POLICY IS SUBJECT TO THE PREMIUMS, FORMS, AND RULES IN EFFECT FOR EACH POLICY PERIOD. SHOULD THE "
POLICY BE TERMINATED, THE COMPANY WILL GIVE THE ADDITIONAL INTEREST IDENTIFIED BELOW 10 DAYS
WRITTEN NOTICE, AND WILL SEND NOTIFICATION OF ANY CHANGES TO THE POLICY THAT WOULD AFFECT THAT
INTEREST, IN ACCORDANCE WITH THE POLICY PROVISIONS OR AS REQUIRED BY LAW.
::ARRrtll.N.#.MIRtj,ij,,"lI:I:i::::::=:@::i:it:iiIi:@if:i:t::::::::i:::::ttt:t::!:!::tti:It::::m:::l!:m::::!::;:::t@1I??i;IIIt:i:Ii::::ti::::::r:::::::::l:i:?i:::t::::l:I:?:li::::flI:tlIi:iii:i:iI::::::::I:::i:::::I:::tI:i:::::::iI::@:::r}t::r::~i:::::::::::::::::::::::i:::i:::::f:::l:::::::::;i::::::ii:=::::::i:irr:iI::
NAME AND ADDRESS MORTGAGEE X ADDIT/ONALINSURED
CITY OF CLEARWATER
PARKS AND RECREATION DEPT
100 S MYRTLE AVE
CLEARWATER FL 33756 AUTHORIZED REPRESENTATIVE
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LOSS PAYEE
LOAN #