CERTIFICATE OF LIABILITY INSURANCE
~
From:ACORDIA TA DEPT
727 799 5117
05/30/2006 17:13 #007 P.001/002
If A CORD,.. CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIODIYYI
05/30106
:
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER 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 INSURER A: FIREMAN'S FUND INSURANCE CO
Clearwater Country Club AUTO OWNERS-09703
Management, Inc. INSURER B:
525 North Betty Lane INSURER C: BRIDGEFIELD EMPLOYERS INS CO
,Clearwater FL 33755 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.
INSR TYPE OF INSURANCE POLICY NUMBER ~<i~~r=~~"~ P8k!fEYI~~~~J.J~r LIMITS
LTR
A ~NERAL LIABILITY MZX80853447 1/01/06 1/01/07 EACH OCCURRENCE $ 1000000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone tirel $ 100000
I CLAIMS MADE W OCCUR MED EXP (Anv one person' $ 5000
I-- PERSONAL & AOV INJURY $ 1000000
I-- GENERAL AGGREGATE $ 2000000
n'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG $ 2000000
POLICY n ~~gT n LOC
B AUTOMOBILE LIABILITY 9562406000 1/01/06 1/01/07 COMBINED SINGLE LIMIT
f-- $ 1000000
~ ANY AUTO (Ea accidenll
I-- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person'
I--
~ HIRED AUTOS BODILY INJURY
$
~ NON-OWNED AUTOS (Per accideml
c-- PROPERTY DAMAGE $
(J>St accident)
~AGE LIABILITY AUTO ONLY. EA ACCIDENT S
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A EXCESS LIABILITY XAU87724654 1/01/06 1/01/07 EACH OCCURRENCE $ 5000000
~ OCCUR D CLAIMS MADE AGGREGATE $ 5000000
$
R DEDUCTIBLE $
RETENTION $ $
C WORKERS COMPENSATION AND 83028251 1/01/06 1/01/07 I T1J~.;r~~s I IOTH-
ER
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT $ 500000
E.L. DISEASE. EA EMPLOYEE $ 500000
E.L. DISEASE. POLICY LIMIT $ 500000
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSlVEHICLESIEXCLUSJONS ADDEO BY ENDORSEMENT/SPECiAl PROVISIONS
CERTIFICA TE HOLDER IS ADDITIONAL INSURED RE:GENERAL LIABILITY ONLY
FAX 727-562-4825
10 DAY NOTICE OF CANCELLATION FOR NONPAYMENT OF PREMIUM
CERTIFICATE HOLDER I X 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 W'LL ENDEAVOR TO MAIL ---1Q...
DAYS WRITTEN
P.O. BOX 4748 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHAlL
CLEARWATER, FL 33758-4748 IMPOSE NO OBLIGATION OR L1ABlUTY OF ANY KIND UPON THE INSURER, ITS AGENTS DR
REPRESENTATIVES. II
AUTHO~REPR~ATIVE
I , , II " n
- - ,
ACORD 25 S (7/97)
46 66
. ACORD CORPORATION 1988/