CERTIFICATE OF LIABILITY INSURANCE (4)UPARC -1
OP ID: GD
ACORCr
`,.,- CERTIFICATE OF LIABILITY INSURANCE
DATE (MM /DD/YYYY)
03/28/2014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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).
PRODUCER Phone: 727-447-6481
Bouchard - Clearwater
101 Starcrest Drive Fax: 727 -449 -1267
P 0 Box 6090
Clearwater, FL 33758 -6090
J Raymond Bouchard, CIC
CONTACT
PHONE
(A/C. No, Ext): FAX No):
ADDRESS: cicerts @bouchardinsurance.com
INSURER(S) AFFORDING COVERAGE
NAIL #
INSURER A: Bridgefield Casualty Ins Co
10335
INSURED UPARC, Inc.
UPARC Foundation
1501 North Belcher Rd, Ste 249
Clearwater, FL 33765 -1302
INSURER B : New Hampshire Insurance Co
23841
INSURER C : Granite State Insurance Co
23809
INSURER D:
$ 1,000,000
INSURER E :
$ 250,000
INSURER F :
$ 10,000
•
REVISION NUMBER:
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
• ..
INSR
1 = -1
WVD
POLICY NUMBER
POLICY EFF
(MM /DD/YYYY)
POLICY EXP
(MM /DD/YYYY)
LIMITS
Ci
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
[ ���
02LX006264071 { +
^i
} r
`, s; <
a ! If /2013
j.
,1
12/01/2014
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 250,000
(Any
MED EXP ( y one person)
$ 10,000
■■
CLAIMS -MADE
X
OCCUR
PERSONAL 8 ADV INJURY
$ 1,000,000
■
GENERAL AGGREGATE
$ 3,000,000
PRODUCTS - COMP /OP AGG
$ 3,000,000
GEN'L AGGREGATE
POLICY
LIMIT APPLIES
PRO
JECT
X
PER:
LOC
Prof Liab
$ 1,000,000
B
AUTOMOBILE
X
■ALL
X
LIABILITY
ANY AUTO
OWNED
AUTOS
HIRED AUTOS
X
SCHEDULED
AUTOS
AUTO NON -OWNED S
E
° -
01 CA0093485146000
,;,: -�:
12/01/2013
12/01/2014
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
(Per accidentDAMAGE
)
$
$
B
X
■
UMBRELLA LIAB
EXCESS LIAB
X
■
OCCUR
CLAIMS -MADE
01UD0007738936000
12/01/2013
12/01/2014
EACH OCCURRENCE
$ 2,000,000
AGGREGATE
$ 2,000,000
$
DED X RETENTION $ 10,000
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
Y / N
N
019603019
04/01/2014
04/01/2015
X
WC STATU-
TORY LIMITS
OTH-
ER
E L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space is required)
I
CICLEAR
CITY OF CLEARWATER
PO Box 4748
Clearwater, FL 33756
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2010/05)
1988 -2010 ACORD CORPORATION. All rights reserved.
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