CERTIFICATE OF LIABILITY INSURANCE (2)
Mar 30 2005 10:19AM
HP LASERJET FAX
p. 1
ACORo'M
CERTIFICATE OF LIABILITY INSURANCE
DATE IMMIDOIYVVY)
03/30/2005
THIS CERTIFICATE IS ISSUED AS A MAneR 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.
PRODUCER (727) 789-1488
Long & Company Inc
29190 U S Hwy 19 N
POBox 14958
Clearwater
INSURED
FL
33766-4958
IN$URERS AFFORDING COVERAGE
INSURER A: TRAVELERS INSURANCE CO
INSURER B:
INSURER C:
INSURER D:
INSURER E:
NAIC#-
AFRICAN AMERICAN LEADERSHIP COUNCIL
12Q1 Douglas Avenue
Clearwater FL 33755-
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.lHE TERMS. EXCLUSIONS AND CONOmONS OF SUCH POLICIES,
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ~~~~ TYPE OF INSURANCE POLICY NUMBER Pt?A'{~~r:68,w~ Pgk~r~~~N UNITS
LTR
A X GENERAL L1AEiIUlY r-660-10BX5326-TCT-05 02/14/2005 02/14/2006 EACH OCCURRENCE $ 500,000
...::c;;. , ~~~H?~~,
X COMMERCiAl GENERAL LIABILITY $ 100,000
I CLAIMS MAllE ~ OCCUR I I / I MEDEXP~nvoneDB~n\ $ 5,000
- PERSONAL&AOVIN~RV $ 500,000
I / I I GENERAL AGGREGATE $ .500,000
-
GEN'L AGGREnE LIMIT nS PER: PRODUCTS. COMPIOP AGO $ 500,000
~' PRO- -- - -.. 11"'- I / / I
POLICY JECTLOC
AUTOMOBILE LIABILITY ,.V[;;LI I / / I COMBINED SINGLE LIMIT
- (Ea ea:ldenl) $
ANY AUTO
to-- APR 0 6 2005 I / / I
ALL OWNED AUTOS BODILY INJURY
f- (Per person) $
SCHEDULED AUTOS
'-- / I / I
HIRED AUTOS OFFICIAL RECORDS AND BODilY INJURY
- (Per accident) $
NON-OWNED AUTOS LEGISLATIVE SRVCS DEPT
f- I I / I
PROPERTY DAMAGE
(f'.... accident) $
, GARAGE LIABILITY AUTO O/'ll Y -EA ACCIDENT $
==1 ANY AUTO I / I I OTHER "THAN EAACC $
AUTOONlV: AGO $
::.=JESS/UMBRELLA LIABIUTY I I / I EACH OCCURRENCE $
OCCUR D CLAIMS MAllE AGGREGATE $
$
R DEDUCTIBLE I / / I $
RETENTION $ tlfE~mJr'I's I $
WORKERSCOMPENSA~ONAND I I I I IOl~-
EMPLOYERS'LIABILlTY
ANY PROPRI ETORJPARlNERiEXECUTIVE E, LEACH ACC IDEiIIT $
OFFICERlMEMBER EXCLUDED? I / I / E.L DISEASE - EA EMPlOYEE S
If yes, describe under
SPECIAL PROVISIONS below . E.L DISEASE - POLICY LIMIT S
OTHER / I J I
I / J /
/ / I I
DESCRIP110N OF OPERA-rIONSlLOCATIONSNEHICLESfEXCLUSlONS ADDED BY ENDORSalIENT1SPEctAL PROVISIONS
1201 Douglas Avenue I Clearwater, Ji'L - Claarwater Parks & Re=_tion Departmant rncludad as Additional insured - Lessor
Risk ofil.y
CERTIFICATE HOLDER
( )
CANCELLATION
Clearwater Parks & Recreation
Attn: Art Kadir
Transm~tted by fax:
727-562-4825
ACORD 25 (2001/08)
~TM- INS025 (D1V6),Q5
SHOULO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DAle THEREOF. lltE ISSUING INSURER WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NonCE TO 1lfE CEFmFlCATE HOlDER NAME:D TO THE LEFT, BlIT
FAILURE TO DO so SHALL INPOSE NO DRUG N OR LIABILITY OF ANY KIND UPON THE
INSURER,. ENTS R E9 A S
AUTtIORI A E
~ACORD CORPORATION 1968
~ Pagel 012
ELECTRONIC LASER FORMS,INC, -(600)327-ll545