CERTIFICATE OF LIABILITY INSURANCECORD®
FICATE OF LIABILITY INSURANCE
DATE
(MM /DD/YYYY)
03/04/2014
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 INSURERS(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
Lockton Affinity, LLC
P.O. Box 873401
Kansas City, MO 64187 -3401
CONIXT
611WE
PHONE =AX
(NC No.Ext): 888 - 553 -9002 A/C, No):
E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC
INSURER -A: ACE American Insurance Co.
22667
INSURED
Habitat for Humanity of Pinellas County, Inc., Pinellas County Habitat for
Humanity Community Housing Development Organiz
13355 49th Street North,
Clearwater, FL 33762
INSURER -B:
INSURER -C:
04/01/2014
(� '•
INSURER -D:
EACH OCCURRENCE
INSURER -E:
PR (Ea PREMISES ( ( RENTED
Ea occurrence)
INSURER -F:
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.
IN
SR
LT
R
TYPE OF INSURANCE
ADDL
INSR
SUB
R
WVD
POLICY NUMBER
POLICY EFF
(MM /DD/YYYY)
POLICY EXP
(MM /DD/YYYY)
LIMITS
A
GENERAL LIABILITY
X
GL1064582 -14
n
04/01/2014
(� '•
04/01 /2015
EACH OCCURRENCE
$ 1,000,000
PR (Ea PREMISES ( ( RENTED
Ea occurrence)
$ 1,000,000
X
OMMERCIAL GENERAL LIABILITY
MED EXP (Any one person)
$ 0
LAIMS MADE
X
OCCURI�
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS — COMP /OP AGG
$ 2,000,000
GEN L AGGREGATE
X bOLICY
LIMIT APPLIES
PER:
$
AUTOMOBILE LIABILITY
)
a
"L
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per Person)
$
ANY AUTO
BODILY INJURY (Per accident)
$
ALL OWNED
AUTOS
SCHEDULED
AUTOS
PROPERTY DAMAGE
(Per accident)
$
HIRED AUTOS
NON -OWNED
AUTOS
UMBRELLA LIAB
OCCUR
CLAIMS MADE
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
DED TRETENT ON $
X
WC STATU-
TORY LIMITS
OTH-
ER
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER /EXECUTIVE Y/N
E.L. EACH ACCIDENT
$
OFFICER/MEMBER EXCLUDED? I
E.L. DISEASE— EA EMPLOYEE
$
(MANDATORY IN NH)
If yes, describe under
E.L. DISEASE — POLICY LIMIT
$
pESCRIPTION OF OPERATIONS below
CERTIFICATE HOLDER
CANCELLATION
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
City of Clearwater
P.O. Box 4748,
Clearwater, FL 33758
ACORD 25 (2010/05)
1064582
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