CERTIFICATE OF INSURANCE (2)
PRODUCER
Marsh
3031 N. Rocky Point Drive, Suite 700
Tampa, FL 33607
CERTIFICATE NUMBER
ATL-000915191-03
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
POUCY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
AFFORDED fJ'( THE POUCIES DESCRIBED HEREIN.
COMPANIES AFFORDING COVERAGE
COMPANY
AN/A
INSURED
ALL CHILDREN'S HEALTH SYSTEM, INC.
801 6TH STREET SOUTH
ST PETERSBURG, FL 33701
COMPANY
B ILLINOIS UNION INSURANCE CO
COMPANY
C ADMIRAL INSURANCE COMPANY
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
GENERAL AGGREGATE
TYPE OF INSURANCE
POUCY NUMBER
I POUCY EFFECTIVE POUCY EXPIRATION
DATE IMMlDDIYY) I DATE IMMIDDIYY)
UMITS
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE U OCCUR
OWNER'S & CONTRACTOR'S PROT
PERSONAL & ADV INJURY
EACH OCCURRENCE
1$$
PRODUCTS - COMP/OP AGG
$
,$
$
$
1$
-r;
BODILY INJURY
(Per person)
..L..-
I BODILY INJURY
I (Per accident)
$
PROPERTY DAMAGE
B i EXCESS UABIUTY
f-------1
j I UMBRELLA FORM
i--xl OTHER THAN UMBRELLA FORM
i WORKERS COMPENSATION AND
i EMPLOYERS' UABlUTY
XHLG 21685501 003
112/15/04
I
12/15/05
i AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
I EACH ACCIDENT I $
i AGGREGATE: $
i EACH OCCURRENCE I $
I AGGRE~I~____..__ 1-$
1$
10,000,000
10,000,000
, GARAGE UABlUTY
I
o ANY AUTO
, I
I
:----i
i
i
i THE PROPRIETOR!
I PARTNERS/EXECUTIVE
I OFFICERS ARE:
THER
~INCL
I : EXCL
EL DISEASE-POLICY LIMIT i $
i EL DISEASE-EACH EMPLOYEE I $
C PROFESSIONAL LIABILITY/
GENERAL LIABILITY
EXCESS OF CARRIER B
DESCRIPTION OF OPERATlONS/LOCATlONSNEHICLESlSPECIAL ITEMS
GENERAL LIABILITY SUBJECT TO $1,000,000/$2,000,000 SIR. PROFESSIONAL LIABILITY SUBJECT TO $3,000,0001$9,000,000 SIR. THESE ARE
POLICY LIMITS AND NOT APPLIED TO INDIVIDUAL STAFF MEMBERS.
'CES FL-10071-1203-02
! 12/15/04
12/15/05
:
I PER INCIDENT/OCC $10,000,000
: AGGREGATE $10,000,000
Parks and Recreation Director
POBox 4748
Clearwater, FL 33765
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION OATE THEREOF,
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL --30 DAYS _'TTEN NOTICE TO THE
CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KINO UPON THE INSURER AFFORDING COVERAGE. ITS AGENTS OR REPRESENTATIVES, OR THE
ISSUER OF THIS CERTIFICATE.
MARSH USA INC.
BY: Shelia D. Robertson
SUN. D ~