CERTIFICATE OF LIABILITY INSURANCE (15)
OP 10 S DATE (MM/DD1YYYY)
HEADS-2 12 28 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.
ACORD.
CERTIFICATE OF LIABILITY INSURANCE
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.
LTR NSRC TYPE OF INSURANCE POLICY NUMBER 'D~~1MM/DD1YYl I P~k!fe'y(MM/DD1YY'j LIMITS
'- 'GENERA[:UABlLITY - -- . EACI'tOeCURRl!NCE- . $1000000
-
A X X COMMERCIAL GENERAL LIABILITY G20400869 01/01/07 01/01/08 PREMISES (Ea occurence) $ 100000
1 CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5000
~ Prof/Sex Abuse PERSONAL & ADV INJURY $ 1000000
GENERAL AGGREGATE $ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2000000
~ .nPRO- n Emp Ben. 100/300
X POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $ 500000
A ~ ANY AUTO H08123032 01/01/07 01/01/08 (Ea accident)
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per parson)
-
HIRED AUTOS BODILY INJURY
- $
NON-OWNED AUTOS (Per accident)
-
e-- PROPERTY DAMAGE $
(Per accidant)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
:=J OCCUR 0 CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
'WOftK!!ftS COM~E:1~8M'ION ANa " --- e-. .,,:1 Til ~~~- ---- ..
B EMPLOYERS' LIABILITY 30610266 01/01/07 01/01/08
ANY PROPRIETORIPARTNERlEXECUTIVE E.L. EACH ACCIDENT $ 100000
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 100000
~~~~:s~~v'ffi~~~s below E.L. DISEASE - POLICY LIMIT $ 500000
OTHER
C Mt Hawley MCP0134583 OS/24/06 OS/24/07 Property Schedule on
D Endurance Special. CPN10000155500 OS/24/06 OS/24/07 File with Aaenc
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Certificate holder is an additional insured for general liability only with
regard to 701 N. Missouri, Clearwater, FL
PRODUCER
Brown & Brown Insurance
17757 US Highway 19 N, Ste 660
P.O. Box 2456
Clearwater FL 33757-2456
Phone: 727-461-6044 Fax:727-442-7695
INSURED
Head Start Child Development
& Family Services
~f~~lr:;hp~~~n~'3~~~~50~~
COVERAGES
CERTIFICATE HOLDER
CITYOFC
City of Clearwater
ATTN: Earl Barrett
P.O. Box 4748
Clearwater FL 33758-4748
ACORD 25 (2001/08)
INSURERS AFFORDING COVERAGE
NAIC#
22667
10699
37974
41718
INSURER "'-
INSURER B:
INSURER c:
INSURER 0:
INSURER E:
Ace American Insurance Co
FL Hospi tali ty Mutual Ins. Co.
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHO 0 RESENT VE ~
@ACORDCORPORATION 1988