CERTIFICATE OF LIABILITY INSURANCE (3) CERTIFICATE. . �. �p11,22/2015 rMM/1'�rlr'r"YYYI
OF LIABILITY INSURANCE 9/
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 TIME CERTIFICATE HOLDER_
IMPORTANT: If the certificate holder is an ADDITIONAL INSURER,the;-licRies)must he endorsed. If SUBROGATION IS WAIVED,sutrlect t0
the terms and conditions)of the Policy,certawin policies may require an endorsement. A statement on this certificate does not confer rights to the
cediftate holder in lieu of such endorsement s
PROovCL"rr Thomas R.oyster
Lancaster Insurance
(72 )4fi1 3'' Tito. l:aaz�,ra� ee,
510 Druid It.a Ste. #C �, L " m........ _
Al,r Y ste�arinsur com
P C� x 2856 tcan.scr �mtarCllzerx ._..
- rNSURC'�S #ffF0ftDI!MGC�7VERAGE NAIC*
Clearwater 33757
imwRr~RA.Southeern-Owners Insurance 10190
IN3VRIEo -_ .W._ _ .._... ..
INSUaeER m
_..._ _ _
Clearwater Lawn Bowls r�I11c
1040 Calumet. St _ __._. —_ ............
R las
.... _.
Clearwater Fi, 33755-1615 s BrR I=• —.�.�.
COVERAGES CERTIFICATE NLIMI ER:C]41551011572 REVISION N .
THIS IS TO CERTIFY THAT THE POLICIFS OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A50V'E FOR THE POLICY PERIOD
INDICATED NOTWTHSTANOINC ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WVFIICH 1W418
CER-TIFICATE MAY E ISSUED OR MAY PPRT�THE ENSURE AFF41�IXD BY Tk POLICIES DESCRIBED HEREIN IS SUBJECT'TO ALL THE TERMS,
EY�CL(SItINS ANi3 C I DITIONS Of SUCH f"CYI fUES.LIMIT'S SHOWN MAY HAVE BEEN REDUCED BY PAIR CLAIMS.
TYPE OF relrAraE POLICY EFi { CY EI ....�
M LCT
'C(IIFIIlEIrCLAL GErISUL UAR4
EACH OCCURRENCE....... ......
000,0001
A 1 CLAIMS•MASG � 7GCLR WL CIi 1
50,000
m - X 20614,8127 4/20/2018 4/20/2026 !jfnE%Pj4na
'SABNAL d:Ami7V e MR Y) S 5,000
00
CE
GEN'L AG-3a7RarE IMIT APP RUES PER N!1- _S
GENERAL AGGREGATE
21000,TI fltt
POLICY LOC
PIRI7CUCTEb-CCrAPVOP AG�C.s 2,000,000
" .,._.... ,,. .a..e_........_. _._......__
CdTFIEr#- 15MMOM101,aream $
AUTOMOBILE UA131LATY..... COMB04ED..$INGLE LIMIT �......
a
ANY AUTO
ALLOWNED ; 6 HEDULEEI E7CYOILY MLRIi YIPsa----- l &
AUTOS AIIT' BODIL:INJIIUPYrPWaac0entl $
HIREr7A1ITGS NOW-OWNED .._;r.,.„,.,......
AUTOS DAMAGE
UMBMLLALIAM 0CC,, EACH OCCURRENCE �
EXCESS UAR .......... ...._...
a. . j CLAIMF-MAGE
DIED RETPNTION
WORKERS COMPENSATION PER
ANY PRC)p3d1£TC7 LIwr,RILITY YON' 'EL EACHTT °R.. ,......°.._m.._..._.._..„
AND EMPLOYE
R7 EXCk.NEPifE.�7L.LU'CI'VE Er..t DISFASL�IUFIvrT
�rMarI . dese a OF UI'EfdA7I. Gett7N1
tidl ip In"H)ClfFiCIERI'rtIEMErE'Fk E7S+Cl.I,Nw�'E.Ca'� A NIA EA EMPL4AY
tt tea,E+rscnbe undaa' w
i 1
EA,CXSEASE'-POLICY LIMIT I S
"SCRIr" ON Of OPERATIONS i LOCATIONS I'VEHMLES IACC7 O"l,A401464 Remarks Schadurs,may be wnchod R mvn space is r*gwrrdl
city of Clearwater Parkes area Recreation Depaztment is listed as additional insured with respect to the
general liability insurances per the terms, conditions and exclusions of the policy,
roymccartney44.@Fail corm
CERTIFICATE HOLDER CANCELLATION
(727)562-4825 Mike.L kwoodSmyclearvater
SHOULD ANY OF THE ABOVE:DESCRIBED POLICIES BE„CANCELLED BEFORE
City of Clearwater THE iEIIP ION DATE THEREOF. NOTICE WILL BE DELIVERED IN
Parks and Recreation Dept. ACC�dD� 9aIfITH'THE POLICY PR GVISIOKS.
Attn., Mika Lcsckwvac4
$0171 4748 AUTRCD FCEPNE EriTATW
Clearwater, FI 33756
X11988-2i11 A ORD CORPORATICIN. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INS025 I20401 p