CERTIFICATE OF LIABILITY INSURANCE
ACORDN CERTIFICATE OF LIABILITY INSURANCEgLE~~~~ D~ DATE (MMlDDIYY)
06/03/02
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Bouchard-Starcrest ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
101 Starcrest Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
POBox 6090 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater FL 33758-6090
Phone:727-447-6481 Fax:727-449-1267 INSURERS AFFORDING COVERAGE
INSURED INSURER A: AUTO OWNERS INSURANCE CO
INSURER B:
Clearwater Lawn Bowls Club INSURER C:
Carol Rawlings
1040 Calumet St INSURER D:
Clearwater FL 33755
I 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 ~~HfiM~b5~YE P6>1-f~~~~6~J.}?N LIMITS
LTR
GENERAL LIABILITY EACH OCCURRENCE $ 500000
f--
A X COMMERCIAL GENERAL LIABILITY 20614827 02 04/20/02 04/20/03 FIRE DAMAGE (Anyone fire) $ 50000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5000
PERSONAL & ADV INJURY $ 500000
GENERAL AGGREGATE $1000000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 500000
I .nPRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- (Ea accident) $
ANY AUTO
f--
ALL OWNED AUTOS BODILY INJURY
r-- (Per person) $
SCHEDULED AUTOS
f--
HIRED AUTOS BODILY INJURY
r-- $
NON-OWNED AUTOS (Per accident)
r--
f-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
o OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I TO'R~'d~YTS I iU~~-
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
C1ubs-civic/service/social NFP
CERTIFICATE HOLDER I N I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
CICL001 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ...3...0....- DAYS WRtTTEN
City of Clearwater NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Attn: City Clerk
P.O. Box 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Clearwater FL 34618 REPRESENJp..TIVES.
I AUTHOR\!yt:;Z
ACORD 25-5 (7/97)
@ACORDCORPORATION 1988