EVIDENCE OF PROPERTY INSURANCE (4)
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DATE IMM/DDIYY)
11101/06
..
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.
727-796-6666
COMPANY
PRODUCER
Agorpia s.outheast, Inc.
Pq Bbx 31666
Tampa, FL 33631-3666
American Zurich Ins Co-09080
CODEI
AGEN Y
SUB CODE:
ON:
PER54440
THIS REPLACES PRIOR EVIDENCE DATED:
11/01/06
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LocA ION/DESCRIPTION
1 ~. 1 McMullen Booth Rd.
tl~ rwater FL 33759
PACT, Inc., Performing Arts
Center Foundation, Inc.
1111 McMullen Booth Road
Clearwater FL 33759-
EFFECTIVE DATE
10101/06
EXPIRATION DATE
10101/07
CONTINUED UNTIL
TERMINATED IF CHECKED
INSU",D
LOAN NUMBER
POLICY NUMBER
BIND588630
22
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COVERAGE/PERILS/FORMS
AMOUNT OF INSURANCE
DEDUCTIBLE
llui ding Replacement Cost Special
Bu iness Personal Pr Replacement Cost Special
Bulliness Income with Agreed Value Special
EDP.Hardware Replacement Cost Special
Flood Replacement Cost Flood
. . -J G ..... 2r"'~
:,'. j ( .iJJ
40000000
1500000
1841000
289000
5000000
5000
5000
RECEIVED
1000
500000
Building Ordinance 0
OFFICIAL RE:COkU::> AND
lEGISlATIVE SRVCS DFPT
50000
WINDIHAIL DEDUCTIBLE - $5,000,000.
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CITY IS ADDITIONAL INSURED FOR INTEREST HELD IN PREMISES OF
RUTH ECKERED HALL.
I:: ~.:.
L~;
.-d-
NOV 0 6 2006
R l~;h.. ;".f~/j~_..\!;'-i.'.J c;i'~j~ EN T
THE POLICY IS SUBJECT TO THE PREMIUMS, FORMS, AND RULES IN EFFECT FOR EACH POLICY PERIOD. SHOULD THE
POLICY BE TERMINATED, THE COMPANY WILL GIVE THE ADDITIONAL INTEREST IDENTIFIED BELOW 30 DAYS
WRITTEN NOTICE, AND WILL SEND NOTIFICATION OF ANY CHANGES TO THE POLICY THAT WOULD AFFECT THAT
INTEREST, IN ACCORDANCE WITH THE POLICY PROVISIONS OR AS REQUIRED BY LAW.
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NAMl AND ADDRESS MORTGAGEE X ADDITIONAL INSURED
CITY OF CLEARWATER
ATTN: LEO SCHRADER, RISK MGMT
POBOX 4748
CLEARWATER FL 33758-4748
LOSS PAYEE
LOAN N
..............................................................
:]~$~b.J~$.~~OMtl~Mf4~~~
~CORDTM
CERTIFICATE OF LIABILITY INSURANCE
DATE IMM/DDIYYI
11/01/06
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE. CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PROD CER
ACaRDIA EAST - TAMPA BAY
P.O. Box 31666
Tampa, FL 33631-3666
727-796-6666
INSURERS AFFORDING COVERAGE
INSURED
PACT, Inc., Performing Arts
Center Foundation, Inc.
1111 McMullen Booth Road
Clearwater FL 33759
COVERAGES
INSURER A:
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
ZURICH-AMERICAN-09593
ZENITH INSURANCE CO-DB
AMERICAN GUARANTEE & LIABILITY
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
AN!\' 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.
Iff: TYPE OF INSURANCE POLICY NUMBER h~~~iJ~~~~~~ POLICY EXPIRATION LIMITS
0
A GENERAL LIABILITY CP0278060502 10/01/06 10/01/07 EACH OCCURRENCE $ 1000000
-
.X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE {Anyone .firel $ 100000
I.CLAIMSMADE W OCCUR MED EXP (Anyone person) $ 10000
PERSONAL & ADV INJURY $ 1000000
GENERAL AGGREGATE $ 2000000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2000000
I POLICY n P,~gr IXl LOC
A AUTOMOBILE LIABILITY CP0278060502 10/01106 10/01/07 COMBINED SINGLE LIMIT
- (Ea accident) $ 1000000
- ANY AUTO
ALL OWNED AUTOS RECEIVED BODILY INJURY
- $
X SCHEDULED AUTOS (Per person)
rL HIRED AUTOS BODILY INJURY
$
L NON-OWNED AUTOS l;,c I 072006 (Per accident)
- PROPERTY DAMAGE $
f")~j::/("iA I (Per accident)
GARAGE LIABILITY . EG ' J"II'fU AUTO ONLY - EA ACCIDENT $
~ ANY AUTO L - ISLATIVE SRVCS DFPT $
OTHER THAN EA ACC
AUTO ONLY: AGG $
C EXCESS LIABILITY UMB937678902 10/01/06 10/01/07 EACH OCCURRENCE $ 10000000
:iJ OCCUR . D CLAIMS MADE AGGREGATE $ 10000000
$
~ DEDUCTIBLE $
RETENTION $ $
1/01106 1 WC STATU-: I IOTH-
B WORKERS COMPENSATION AND Z836094212 1/01/07 X {nRY LIMITS ER
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
1000000
j,i II - - '. EL DISEASE - EA EMPLOYEE- "$ 100000-0-
E.L. DISEASE - POLICY LIMIT $ 1000000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ::: ,:....;;..' 'iF')
CITY IS ADDITIONAL INSURED FOR INTEREST HELD IN PREMISES OF ,. . I. _I
RUTH ECKERED HALL. o 6 2006
NOV
II' . .
* 1 0 DAYS NOTICE OF CANCELLATION APPLIES FOR NON PAYMENT. * " ~)I\ :/iAI~!\GEtv1ENT
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 WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
ATTN: LEO SCHRADER, RISK MGMT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
POBOX 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
CLEARWATER FL 33758-4748 REPRESENlATIVES. )
AUTH A~ 'I:[Q!
c..,... ~ rr --
I
ACCbRD 25-S (7/971 Ce:> ;?t---{ rfo ~r~746-64 ~lsl @ACORD CORPORATION 1988
I
'"
I ' I
'-I
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).
DISCLAIMER
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.
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AC RD 25-5 (7/97)