CERTIFICATE OF LIABILITY INSURANCE (5)
ACORDTM
CERTIFICATE OF LIABILITY INSURANCE
DATE IMM/DDNY)
11/01/06
THIS CERTIFICATE IS ISSUED AS A MAnER 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.
PRODUCER
ACORDIA EAST - TAMPA BAY
P.O. Box 31666
Tampa, FL 33631-3666
727-796-6666
INSURERS AFFORDING COVERAGE
INSURED
INSURER k
INSURER B:
INSURER C:
INSURER D:
INSUAER E:
ZURICH-AMERICAN-091i93
ZENITH INSURANCE CO-DB
AMERICAN GUARANTEE & LIABILITY
PACT, Inc., Performing Arts
Center Foundation, Inc.
1111 McMullen Booth Road
Clearwater FL 33759
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLlCV PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDlTlON 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 POUCY NUMBER ~~~Y EFFECTIVE P~~~~V EXPIRATION UMITS
E
A ~ERAL .UABIUTY CP027B0601i02 10/01106 10/01/07 EACH OCCURRENCE $ 1000000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any ona flra] . 100000
I Cl.AIMS MADE W OCCUR MEO EXP (Any ona parson) $ 10000
~ PERSONAL & ADV INJURY . 1000000
- GENERAL AGGREGATE $ 2000000
n'LAGGREn LIMIT AP~ PER: FRDOUCTS. COMFIOF AGG . 2000000
FOUCY ~~;. X LOC
A ~TOMOaILE LlABIUTY CP027B060602 10/01/06 10/01/07 COMBINED SINGLE LIMIT
lea accldant) $ 1000000
- ANY AUTO
- ALL OWNED AUTOS BODILY INJURY
$
.-X SCHEDULED AUTOS Iper parsonl
.-X HIRED AUTOS BODILY INJURY
$
.-X NON.OWNED AUTOS IFa, eccldent!
- FROPERTY DAMAGE $
(Fer accldantl
~AGE L1ABIUTY AlITO ONLY. EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC .
AUTO ONLY: AGG .
C EXCESS L1ABI ~rTY UMB93767B902 10/01/06 10/01/07 EACH OCCURRENCE . 10000000
::iJ. OCCUR D CLAIMS MADE AGGREGATE' . 10000000
.
==J DEDUCTIBLE $
RETENTION $ .
B WORKERS COMPENSATION AND ZB36094212 1/01/06 1/01/07 X 1.ro~iI~~s I IOl.tl.
EMPLOYERS' UABIUTY E.L. EACH ACCIDENT $
1000000
E.L DISEASE. EA EMPLOYEE . 1000000
E.L. DISEASE. POLICY LIMIT . 1000000
OTHER
DESCRIFTION OF OFERATIONS/LOCATlONSNEHICLES/EXCWSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CITY IS ADDITIONAL INSURED FOR INTEREST HELD IN PREMISES OF
RUTH ECKERED HALL.
.10 DAYS NOTICE OF CANCELLATION APPLIES FOR NON PAYMENT,-
CERTIFICATE HOLDER I X I ADDITIONAL INSURED: INSURER LETTER: CANCELLATION
SHOUUO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEI'ORE 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 00 SO SHALL
POBOX 4748 IMPOSE NO OBLIGATION OR UABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
CLEARWATER FL 33758-4748 REPRESEHrATlVES. J
AllT'L,. A~~A
I ....., . "4tIJ f r
ACORO 25-5 (7/97)
46- 64
Cil ACORD CORPORATION 1968
IMPORT ANT
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(sl.
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 Insureds}, 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.
ACORD 25-5 (7/97)
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
727-796-6666
COMPANY
Acardia Southeast, Inc.
PO Box 31666
Tampa, FL 33631-3666
American Zurich Ins Co-D9DeO
CODE:
AGENCY
C
INSURED
SUB .CODE:
PER 54440
PACT, Inc., Performing Arts
Center Foundation, Inc.
1111 McMullen Booth Road
Clearwater FL 33759-
efFECTIVE DATE
10/01/0B
POUCY NUMBER
BIN05BSB30
EXPIRATION DATE
10/01107
22
LOAN NUMlIER
CONTINUED UNTIL
TERMINATED IF CHECKED
THIS REPLACES PRIOR EVIDENCE DATED:
11/01/0B
LOCATION/DESCRIPTION
1 1 1 1 McMullen Booth Rd.
Clearwater FL 33759
COVERAGE/PERILS/FORMS
AMOUNT OF INSURANCE
40000000
1500000
1841000
289000
5000000
DEOUCTIBLE
5000
5000
Building Replacement Cost SpecIal
BusIness Personal Pr Replacement Cost Special
BusIness Income with AGreed Value Special
EDP.Hardware Replacement Cost Special
Flood Replacement Cost Flood
1000
500000
Building Ordinance D
50000
WIND/HAIL DEDUCTIBLE - $5,000,000.
~:t{slj!U~ll~$]In:s!@mij::;~i.M!:#'!'jl~9.@mM!H;1}flIl!lHJirHMJtUmm@~:ifMmtMmlll@It;rmtllEM;t:iMf:m\tmNlf:@::;::::f::;:::::liI:1@f:I@;r:ml}IJi:UJ%f:l:::lftl;JW:lff::=;:;mili
CITY IS ADDITIONAL INSURED FOR INTEREST HELD IN PREMISES OF
RUTH ECKEREO HALL.
THE POLICY IS SUBJECT TO THE PREMIUMS, FORMS, AND RULES IN EFFECT FOR EACH POLICY PERIOD. SHOULD THE
POLlCY 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.
i:AQP.!1tl~N.A~1N.!~J]g~mna::lttiflUm1t@fJ:Mili&W:hW@mEm1~m;gg;m:mmmnm:~@1M11mM]Mf;H::f:::~:flq:=:::gmfnm:nM:::I@Mr:ttt:ml:~t~m:U=::::Hlmt::M::ti]llH:~fm::r
NAME AND ADDRESS MORTGAGEE X ADDITIONAL INStJIUlD
CITY OF CLEARWATER
ATTN: LEO SCHRADER, RISK MGMT
POBOX 4748 ~
CLEARWATER R. 33758-4748 L L
1l~l~~i;r1fi1?;;fifiM!i'iEJ&(t:;;rr:'!,9'miir%WW_~fA$1i~~Wi1~5~t~qjijr;aQij_;1l9J,l'lii~~
LOSS PAVEE
LOAN II