CERTIFICATE OF LIABILITY INSURANCE
ACOR~M CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
08/06/07
PRODUCER 1-800-524-0191 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Art~iJ.r J. Gallagher Risk Management Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
7380 W. Sand Lake Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 390
Orlando, FL 32819 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Chicago Insurance Co
Florida Community Colleges Risk Management Consortium
INSURER B:
5700 SW 34th Street INSURER C:
Suite 1205 -
Gainesville, FL 32608 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 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSR ~~~~ ~~2!;~~~~N LIMITS
LTR POLICY NUMBER
GENERAL LIABILITY . -- - CL..I EACH OCCURRENCE $
f-- ~~~~~'E~ ?E~~~~~nce\
f-- ~MMERCIAL GENERAL LIABILITY $
. CLAIMS 1v'.ADE D OCCUR SE? 2 '3 2 007 MED EXP (Anyone person) $
PERSONAL & ADV INJURY $
f-- 01
f-- FlelA!. RECOR P$ AND GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: LE :7ISLATiVE SRV< S DEPT PRODUCTS - COMP/OP AGG $
I POLICY n j~8T n LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
-
- ALL OWNED AUTOS BODILY INJURY
RECEIVE $
SCHEDULED AUTOS D (Per person)
-
HIRED AUTOS
- BODILY INJURY $
NON-OWNED AUTOS .~ EP 1 9 200 (Per accident)
- ~
- PROPERTY DAMAGE $
il::ll.il'o ~ . (Per accident)
RRAGE LIABILITY ~ AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EAACC $
AUTO ONLY: AGG $
OESS/UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I TV;:;~$I~JI~S I IOJ~-
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT ~-
--~---
OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $
If yes, describe under
SPECIAL PROVISIONS below EL DISEASE - POLICY LIMIT $
OTHER
A Student Professional Liab AHC2900001 08/26/07 08/26/08 Each Incident 2,000,000
General Aggregate 4,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Re: St. Petersburg College Clinical Experience for EMS Program. Coverage includes College Faculty Members for
instruction/supervision of students only.
CERTIFICATE HOLDER
CANCELLATION
J.,i/tL/CM 5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater CC DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
/6tL NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
PO Box 4749 ~: ~~t- IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES,
Clearwater, FL 32618 AUTHORIZED REPRESENTATIVE /k-rp
USA ,-,', ~ -~> ~-/"'~'
ACORD 25 (2001/08) ke11dav
6801011
@ ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001/08)