CERTIFICATE OF LIABILITY INSURANCE (8)
From:ACORDIA TA DEPT
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727 799 5117
05/10/2006 10:05 #788 P.001/002
r ACORaM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYI
5/10/06
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Acardia Southeast, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O.,/3ox 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 Chi Chi Rodriguez Youth INSURER A: ZURrCH-AMERICAN-212-16535
Foundation, Inc. INSURER B: Zenith Insurance Co-DB
3030 McMullen Booth Road INSURER C:
IClearwater FL 33761 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 REOUIREMENT, 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~.f: TYPE OF INSURANCE POLICY NUMBER ~UCY EFFECTI~~ Pg1rNI~J:~~~r LIMITS
A GENERAL LIABILITY CP0379371803 2/01/06 2/01/07 EACH OCCURRENCE $ 1000000
-
X COMMERCIAL GENERAL LIABILITY FIRE OAMAGE (Anyone lirel $ 1000000
I CLAIMS MADE W OCCUR MED EXP IAny on. person) $ 5000
PERSONAL & ADV INJURY $ 1000000
-
GENERAL AGGREGATE $ 2000000
-
~'L AGGREn LIMIT APn PER: PRODUCTS. COMP/DP AGG $ 2000000
X POLICY ~~gT LOC
A ~TOMOBILE LIABILITY BAP299722105 2/01/06 2/01/07 COMBINED SINGLE LIMIT
(Ea accident) $ 1000000
eL ANY AUTO
I--- ALL OWNED AUTOS BOOIL Y INJURY
(Per person) $
f-- SCHEDULED AUTOS
~ HIRED AUTOS BODILY INJURY
(Per accidenU $
~ NON-OWNED AUTOS
PROPERTY DAMAGE $
IPer accident I
GARAGE LIABIUTY AUTO ONLY - EA ACCIDENT $
t=1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A EXCESS UABIUTY UMS931027903 2/01 106 2/01/07 EACH OCCURRENCE $ 1000000
::KJ OCCUR D CLAIMS MADE AGGREGATE $ 1000000
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND Z836521206 2/01/06 2/01/07 I WC STATU- l IOTH-
S TORY J.JMITS EA
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
1000000
E.L DISEASE - EA EMPLOYEE $ 1000000
E.L DISEASE. POLICY LIMIT $ 1000000
OTHER
OESCRIPTION OF DPERATIONSILOCATlONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED
RE: GENERAL L1ABILTY ONLY,
FAX 727-562-4825 Be
10 DAYS NOTICE OF CANCELLATION FOR NON PAYMENT OF PREMIUM
CERTIFICATE HOLDER I I ADDITIONAL INSURED: INSURER lETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF CLEARWATER DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
PO BOX 4748 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHAll
CLEARWATER FL 33758-4748 IMPOSE NO OBLIGATION DR UABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRES5CiI8,TIVES. -
AUT~ED REP9SENTA~ ( , L
I JI ~
'-A
ACORD 25-S (7/97)
47- 71
@ ACORD CORPORATION 1988