CERTIFICATE OF LIABILITY INSURANCE (45)
AGOR~M CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDD/YYI
9/28/07
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
WELLS FARGO INSURANCE SERVICES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 31666 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tam pa, FL 33631-3666
727-796-6666 INSURERS AFFORDING COVERAGE
--
INSURED ~~A: ZURI CH-AMERI CAN-09 5 93
Ruth Eckerd Hall, Inc.
INSURER B: ZENITH INSURANCE CO-DB
----~--,-
1111 McMullen Booth Road ~~RC: AMERICAN GUARANTEE & LIABILITY
IClearwater FL 33759 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.
I~;: TYPE OF INSURANCE POLICY NUMBER LIMITS
10/01/08 EACH OCCURRENCE
FIRE DAMAGE (Anyone fire)
I M ED EXP (Anyone person) $
PERSDNAL & ADV INJURY ! $
GENERAL AGGREGATE I $
r--
PRODUCTS - COMP/OP AGG $
COMBINED SINGLE LIMIT
(Ea accident!
BODILY INJURY
(Per person)
I
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE I $
{Per accident} !
AUTO ONL Y - EA ACCIDENT 'I $
OTHER THAN EA ACC $
, AUTO ONL Y: AGGI $
10/01/08 I EACH OCCURRENCE
I AGGREGATE
I
!
1/01/08
A GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE W OCCUR
CP0278060504
10/01/07
A AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
X SCHEDULED AUTOS
X HIRED AUTOS
X NON-OWNED AUTOS
CP0278060504
"
, ~~ r-
L
GARAGE LIABILITY
ANY AUTO
C EXCESS LIABILITY
X ' OCCUR D CLAIMS MADE
UMB937678905
10/01/07
B
i
i DEDUCTIBLE
RETENTION
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
Z836094212
1/01/07
I
I
, OTHER
I
I
I
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CITY IS ADDITIONAL INSURED FOR INTEREST HELD IN PREMISES OF
RUTH ECKERED HALL.
'10 DAYS NOTICE OF CANCELLATION APPLIES FOR NON PAYMENT.'
CERTIFICATE HOLDER
X ADDITIONAL INSURED: INSURER LETTER:
CANCELLATION
RECEIVED
OCT 0 2 2007
1000000
100000
10000
1000000
2000000
2000000
1000000
10000000
10000000
1000000
1000660'
1000000
CITY OF CLEARWATER
ATTN: LEO SCHRADER, RISK MGMT
POBOX 4748
CLEARWATER FL 33758-4748
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 DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
ACORD 25-S (7/97) Oe\<o- c. L(;;-(2...\ 46,64
c..c..- ~ P ~1?-5 ; R. \ ~ 'L..
@ ACORD CORPORA TION -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 25-5 (7/97)
..<.....~.....I;I.iElil ts~iliSE...t..6Et.jSiSl.E}bli\l.I:j(.ti..S..KiliSE........?i{......i............:...........................{H......:....................... DATE IMM/DD/YYI
...... ft.P . . p~ ?..V)~,;HY~>SlEr:g.y!I.......gll(..";gggl'1'.ly~.........<..:.................................... 9/2B/07
THIS IS EVIDENCE THAT INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS ALL THE
RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY.
PRODUCER I PHDNE
lA/C. No. ExU. 727-796-6666
WELLS FARGO INSURANCE SERVICES
PO Box 31666
Tampa, FL 33631-3666
COMPANY
American Zurich Ins Co-09080
CODE:
AGENCY
CUSTOMER ID #:
INSURED
I SUB CODE:
PER54440
EFFECTIVE DATE
POLICY NUMBER
CP027B0605 22
LOAN NUMBER
Ruth Eckerd Hall, Inc.
EXPIRATION OATE
CONTINUED UNTIL
TERMINATED IF CHECKED
1111 McMullen Booth Road
Clearwater FL 33759-
10101/07 10101/0B
THIS REPLACES PRIOR EVIDENCE DATED:
9/2B/07
R~QR~fjty.~NfPRMAT~PN.
LOCATION/OESCRIPTION
1111 McMullen Booth Rd.
Clearwater FL 33759
..................
..................
........................
........................
. ......................
.............n......
.........................
...................... ...
. . . . . . . . . . . . . . . . . . . . . . . . . .
....................... ..
............,.............
........................
.............................
............................. ..
.. ........................
..
....
......
,i.f:(\eeEJ\lEFi.
~. v- or: lJ
...,........'..............................-..........,.
............................. .,.. ..............
..............'....,.............................,..'.'.........'..........................
....,....................................
...................'................................................
...........................
..................... ..
',1' (.,j
OFFIC!i\L [~ECOR;Y~
.~.... - ~~
COVERAGE/PERILS/FORMS
AMOUNT OF INSURANCE
DEDUCTIBLE
Building Replacement Cost Special
Business Personal Pr Replacement Cost Special
Business Income with Agreed Value Special
EDP Hardware Replacement Cost Special
Flood Replacement Cost Flood
40000000
1500000
2000000
289000
5000000
5000
5000
1000
500000
Building Ordinance D
50000
WindlHail Deductible $3,200,000
REtEIVED
CITY IS ADDITIONAL INSURED FOR INTEREST HELD IN PREMISES OF
RUTH ECKERED HALL.
RISK MANAGEM!:r,J i -
CITY OF CLEARWATER
ATTN: LEO SCHRADER, RISK MGMT
POBOX 4748
CLEARWATER FL 33758-4748
1\~a~~~~~.! l~
AUTHORIZED REPRESENTATIVE
i'ii#~ J< ~Jjilfjll~iqOJIJji$j!j#jf!QNa~$li