CERTIFICATE OF LIABILITY INSURANCE (11)
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CERTIFICATE OF LIABILITY INSURANCE
CSR TG
YOUNG-8 12/19/06
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
AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
DATE (MM/DDNYVY)
"__ACORD..
PRODUCER
Carlisle Fields & Company, Inc
P.O. Box 7910
Clearwater FL 33758-7910
Phone:727-797-0441 Fax:727-725-3663
INSURERS AFFORDING COVERAGE
NAIC#
Young Women's Christian Assn
Of Tampa Bay
655 Second Avenue South
st. Petersburg FL 33701
INSURER A
INSURER B:
INSURER C
INSURER D'
INSURER E:
Markel Insurance Company
Progressive Commercial
Zenith Insurance company
10193
INSURED
COVERAGES
111E POLICIES OF INSURIINCE LISTED BELOW HAVE BEEN ISSUED TO 111E INSURED NAMED ABOVE FOR 111E POLICY PERIOD INDICATED NOTWI111STIINDING
IINY REQUIREMENT, TERM OR CONDITION OF IINY CONTRACT OR 0111ER DOCUMENT WITH RESPECT TO WHICH 1111S CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURllNCE AFFORDED BY 111E 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 NSR[ TYPE OF INSURANCE POLICY NUMBER DATE (MMiOo,wt DATE (MMlDDNY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
- ~=~ES (E~t:~c~~~ence)
A ~ COMMERCIAL GENERAL LIABILITY 3602SS2583992 10/01/06 10/01/07 $ 100000
=:J CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5000
-
PERSONAL & ADV INJURY $ 1000000
GENERAL AGGREGATE $ 3000000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ 1000000
I n PRO- nLOC Emp Ben. 1000000/3
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $ 1,000,000
B ANY AUTO 047436124 10/22/06 10/22/07 (Ea accident)
-
ALL OWNED AUTOS BODIL Y INJURY
f-- $
~ SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY
f-- $
NON-OWNED AUTOS (Per accident)
f--
f-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONL Y AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1,000,000
A tJ OCCUR D CLAIMS MADE 4602SS2581610 10/01/06 10/01/07 AGGREGATE $ 1,000,000
$
Fxl DEDUCTIBLE $
X RETENTION $10,000 $
WORKERS COMPENSATION AND IT~~ IU~~-
C EMPLOYERS' LIABILITY Z049904504 06/24/06 06/24/07 $ 500000
ANY PROPRIETORIPARTNERiEXECLlTIVE E L EACH ACCIDENT
OFFICERlMEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $ 500000
If yes, describe under $ 500000
SPECIAL PROVISIONS below EL DISEASE - POLICY LIMIT
OTHER
RECEIVED
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
The certificte holder is listed aslessor/additional insured. rE~ 01 2007
*30 Days Cancellation applies to Worker's compensation policies, 10 Days
Cancellation for all other policies - Applies to Florida Employees o()fjllCIAL RECORDS AND
LEGISLATIVE SRVCS DEPT
CERTIFICATE HOLDER
CANCELLATION
CITYCLR
SHOULD ANY OF THE ABOVE DESCRIBEO POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30
DAYS WRITTEN
CITY OF CLEARWATER, FLORIDA
Janet Skinner
612 Franklin st
Clearwater FL 33765-5414
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.
AUTHORIZED REPRE
PORA TION 1988
ACORD 25 (2001/08)