CERTIFICATE OF LIABILITY INSURANCE (3)
FROM :
FRX NO. : 727-581-3184
Feb. 12 2007 08:37PM P2
PRODUC~~ (7Z7)461~H94
Lancaster Insurance Inc.
1210 S. Myrtle Ave.
POBox 2856
Clearwater, Fl 33757
: Ifol'URED Bethany EducationarProgram,
: 1250 Holt Ave
Clearwater, Fl 33755-3342
FAX (727)441-3298
DATE (MM/DDIYYYY)
02/01/Z007
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.
L.:.
ACORQM CERTIFICATE OF LIABILITY INSURANCE
Inc.
INSURERS AFFORDING COVERAGE
INSURER A: Scottsdale
INSURER B:
INSURER C:
INSuReR 0:
INSURER E:
NAIC#
COVERAGES
iME POI.ICIE:$ OF INSURANCE l.ISTED BEl.OW HAvE BEeN ISSUI;O TO THE INSURED NAMED ABOVE FOR THE POUCV PERIOD INOICArlOO,NOTWITHSTANDING
ANY REOUIREMeNT, TERM OR CONDITION OF ANY CONTRACT OR orMER DOCUMENT WITH RESPECT TO WHICH tHIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDE!t) BV.THF.: PQUCIeSi>ESCRIBED HEREIN IS SUBJECT TO ALL THF TERMS, EXCLUSIONS AND CONOITiOI~S OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAlO CLAIMS.
l~~~ ~~l TYPE< OF INSURANCE POUCY NUMBER POUCY EFFECnvE< POUCY EXPIltAllON UMlTS
GENERAL UAIIlUTY CLS1092127 01/03/2007 01/03/2008 liACI-l OCCURRENCE S 1,000.000
I--
X COMMeI'lCIAL GENeFW. ~lABlLITY DAMAGe TO ReNnD s 100,000
- =:J CLAIMS MADE 0 OCCUR Q~.. -
MED r=,xp (Any 01'18 perBO~) S 5.000
-
A -,., PERSONAL & ADV INJURY S 1,000,0.99
GENERALAGGREGAle $ 1,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS.COMP~PAGG $ 1.000.000
~ .nPRO. nLOC
POLICY JECT
AUTOMOBILE LIABlI.ITY COMBINED SINGLE LIMIT
- S
ANY AUTO (Ea aCCident)
f..-
ALL OWNED AUTOS BOOIL Y INJURY
I-- S
SCH EOUL"O AUl'OS (Pet pet"..o~)
f..-
tllRED AUTOS BOOIL Y INJURY
I-- S
NON-OWNED AUTOS (P"r"c::cid8~ll
f..-
>-- PROPERTY DAMAGE S
(Per acclllent)
GARAGE I.IABIUl"l' AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHell. THAN EA ACC S
AUTO ONLY, AGG $
3ESSlUMBREI.l.A IJABlUTY EACH OCCURRIiNCS S
OCCUR 0 CLAIMS w.oe AGGREGATE S
S
i ~. DmUCTIBLE S
.....;...+... . .~IPN $ . S
.. '~'CO~i\l1~;\ND' ~'''..'.. ", 'r.::__ .....; :~'._,:_..~~~.r. .....p..r~ ~~-:..._";".:,.:.,:.;:..:;'O',1' ,'n. ",'," .. WCSTATu. IOJ~:
.-. ..n.
E<MPLOYE<R$' LIABILITY
AAV PROPRIETOR/PARTNER/execUTIVE E.L. EACJ..I ACCIDENT $
OFFICERlMEMBER EXCLUDED? E.L. DISI<ASE - EA EMPLOYEE S
~~~I~r~rMY~S~6NS below E.L, OISeASE . POLICY LIMIT S
OTHI;:R
OCSCAIPTIOIll OF OpeRATIONS /1.0CATIONS/ VEHIClES I EXCLUSIONS ADDeD BY I!)jDORSEMENT I SPECIAL PROVISIONS
SHOULD ANY OF TliE ABOvE OESCRIBED POUCles BE CANCEllED BEFORE THE
EXPIRATION gATe THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NOTICE TO rHE CSRTIFICATE HOLDER NAMED TO THE< LE<FT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABII.ITY
OF AKV KIND uPQN THE IN$lJAER, ITS MEHTS OR REPRESENTATIVES.
REPRES .. ...;>
C; ty of Cl earwater
POBox 4748
Clearwater, FL 33758
ACORD 25 (2001/08)
ACORQM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYV)
10/05/2007
PRODUCER (72 7) 461- 3 704 FAX (727)441-3298 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Lancaster Insurance Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1210 S. Myrtle Ave. HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
POBox 2856
Clearwater, FL 33757 INSURERS AFFORDING COVERAGE NAIC#
INSURED Bethany Educational Program, Inc. INSURER A: Scottsdale
1250 Holt Ave INSURER B:
Clearwater, FL 33755-3342 INSURER c:
INSURER D:
INSURER E:
COVERAGES
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 SHOIJ\/N MAY HAVE BEEN REDUCED BY PAID CLAIM.~.
INSR ADD'L TYPE OF INSURANCE POLICY NUMBER PRHSY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY CLSl313574 01/03/2007 01/03/2008 EACH OCCURRENCE $ 1,000,000
- DAMAGE TO RENTED
X COMMERCIAL GENERAL LIABILITY $ 100,000
~ CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $ 5,000
I--
A PERSONAL & ADV INJURY $ 1,000,000
I--
GENERAL AGGREGATE $ 1,000,000
I--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000
h n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY I:CEI\/r:w COMBINED SINGLE LIMIT
- R {Ea accident} $
ANY AUTO ~ 1 t,..
-
ALL OWNED AUTOS BODILY INJURY
- 0 " ", (Per person) $
SCHEDULED AUTOS II" () (',
, ,
- '..) . ~ ,--,'
HIRED AUTOS BODILY INJURY
- (Per accident) $
NON-OWNED AUTOS ~l .:,,'::"'i'),;',':
- ;7IC t ",,-,-..v ..
- ,dSl ~T\VE PROPERTY DAMAGE $
I.. (Per accident)
GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $
:=j ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
~ OCCUR o CLAIMS MADE AGGREGATE $
$
==l DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND l~~:iIT.\I~ I .. rOJ~-
EMPLOYERS' LIABILITY $
ANY PROPRIETOR/PARTNER/EXECUTIVE EL. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E.L.. DISEASE - EA EMPLOYEE $
If yes, describe under E.L.. DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
ertificate Holder is an Additional Insured as respects General Liability subject to the terms,
onditions, and exclusions of the policy.
CERTIFICATE HOLDER
City of Clearwater
POBox 4748
Clearwater, FL 33758
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESEN TIVE
"
ic,^
@ACORD CORPORATION 1988
0~,\
I"
ACORD 25 (2001/08)