CERTIFICATE OF LIABILITY INSURANCE (40)
A CORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YY)
7/03/07
PRODUCER 727-796-6666 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wells Fargo Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Southeast, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 31666
Tampa, FL 33631-3666 INSURERS AFFORDING COVERAGE
INSURED YMCA of The Suncoast, Inc. INSURER A: NEW HAMPSHIRE INSURANCE CO.
2469 Enterprise Road INSURER B: Zenith Insurance Co-DB
Clearwater FL 33763 INSURER c:
INSURER D:
I INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REOUIREMENT, 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 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLICY NUMBER ~<i~~rM~g%~~~ Pg~.fEY(~JI~~J.:~r LIMITS
LTR
A GENERAL LIABILITY BIND607879 5/31/07 5/31/08 EACH OCCURRENCE $ 1000000
-
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ 1000000
'CLAIMS MADE W OCCUR MED EXP -(Anyone person) $ 5000
- PERSONAL & ADV INJURY $ 1000000
- GENERAL AGGREGATE $ 2000000
~'L AGGREn LIMIT APn PER: PRODUCTS - COMP/OP AGG $ 1000000
POLICY j~g;. LOC
A ~TOMOBILE LIABILITY BIND607879 5/31/07 5/31/08 COMBINED SINGLE LIMIT
$ 1000000
...x ANY AUTO REel ~ IVED (Ea accident)
ALL OWNED AUTOS
- BODILY INJURY $
SCHEDULED AUTOS (Per person)
- AUG 2 2007
HIRED AUTOS
- BODIL Y INJURY $
NON-OWNED AUTOS (Per accident)
-
-1 OFFICIAL REC ORDSAND PROPERTY DAMAGE
LEGI~1 A TIVr.: c tRVCS DEPT (Per sccidsnt) $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A EXCESS LIABILITY BIND607880 5/31/07 5/31/08 EACH OCCURRENCE $ 5000000
~ OCCUR D CLAIMS MADE AGGREGATE $ 5000000
$
=;:i DEDUCTIBLE $
X RETENTION $ 10000 $
B WORKERS COMPENSATION AND 2831447614 7/01/07 7/01/08 ...xL wc STATu-l 10TH-
EMPLOYERS' L1ABIUTY X TORY.1l~~-,-..fi.. --- .--
E.L. EACH ACCIDENT $ 500000
E.L. DISEASE - EA EMPLOYEE $ 500000
E.L. DISEASE - POLICY LIMIT $ 500000
OTHER
DESCRIPTION OF OPERATIONS/LOCAnONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
RE:YMCA PROGRAMS HELD ON CLEARWATER PREMISES.
CITY OF CLEARWATER IS AN ADDITIONAL INSURED WITH RESPECTS TO THE ABOVE
GENERAL LIABILITY POLICY ONLY.
FLA STATUTE MANDATES 10 DAYS NOTICE OF CANCELLATION FOR NONPAYMENT
CERTIFICATE HOLDER I X I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
CITY OF CLEARWATER SHOULD ANY OF THE ABOVE DESCRIBED PDUCIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
PARKS & RECREATION NonCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL
P. O. BOX 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
CLEARWATER, FL 33758 REPRES~T~ES. ^ /\
AUT~~
I
ACORD 25-S (7/97)
47-77
@ ACORD CORPORATION 1988