CERTIFICATE OF INSURANCE (2)
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I"llol)u~ - THIS CERTIFICATE IS ISSUED AS A "A TTER OF INFOR..A noN
0Nl Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT A"END, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
CO"PANJES AFFORDING COVERAGE
Aon Risk Services 01 FL,
7650 W.Courtney campbel I
Su i te 800
Tamp., FL 33607
813-636-3500
If
Inc
Cswy
co..FNlY
A
ST. PAUL FIRE & MARINE
co..FNlY
Boys & Girls Clubs of the B
Suncoast, I nc COtIPNlY
6111 66th Street N. C
Suit. 200 co..FNlY
St. Pe ersbur Fl 33709 D
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THISIS TO CERTIFY THA TTHEPOLICIES OF INSURANCELISTEDBELOWHA VEBEENISSUEDTOTHEINSUAEDNAMEO ABOVE FOR THE POLICY PERIOD
INDICA TED,NOTWITHST ANDING ANY REQUIREMENT, TERMOR CONDITIONOFANYCONTRACTOR OTHERDOCUMENTWITHRESPECTTOWHlCHTHS
CERTIFICATE MA Y BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POUClES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERws
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS. '
co TYN OF ".""ANCE POLICY NUMaIll POUCY ....CT1VE POLICY IllPIRA
LTIl DATE CMIIIDDiYY) DAn (MMIDDIY't) LIMn
EMPLOYERS SELF INSURANCE FUND
GENERAL UAILITY C3ENERAl. AGGREGATE .
A COt.t.ERCIAl aBERAl LIABiliTY CK00903330 9/18/96 9/18/97 PROOUCTs.cOWP/OP ABa .
ClAIMS WADE W OC~ PERSONAl 1 ADV IN.UlY S
OWhER'S 1 CONTRACTOR'S PROT EACH ~ .
FIRE DAMAGE (Any _ flra) .
liED EXP (Any _ person) .
AUTOMoa... UAILITY COMBltED SINaLE LIMIT
S
A X ANY AUTO CK00903330 9/18/96 9/18/97
ALL OWNED AUTOS BOOll Y IN.lJRY .
~AUTOS (per person)
A X HIRED AUTOS BOOll Y IN.lJRY .
A X NON-OWNED AUTOS CK00903330 9/18/96 9/18/97 (Per accident)
X Phv Damaae PROPERTY DAMAGE .
A CK00903330 9/18/96 9/18/97
GARAGE UAlLITY AUTO ON.. Y . EA ACCIDENT .
ANY AUTO OllER THAN AUTO ON.. Y:
EACH ACCIDENT .
AGGREGATE .
EXCEII UAILITY EACH OC~ .
A lMlRELLA FORM CK00903330 9/18/96 9/18/97 AGGREGATE s
OllER THAN W8RELLA FORM .
WOIUCERI COMPENIATlON AND X STAMORY LIMITS
B EMPLoYEJtI'LIAILnY 0830-14799-0000 4/01/96 4/01/97 EACH ACCIDENT S
TIE PROPRIETORI 'NO.. DISEASE . POLICY LIMIT S
PARTNERSIEXECUTIVE
OFFICSlS ARE: EXCl DISEASE. EACH Et.f>LOYEE S
Onto
1000000
1000000
1000000
1000000
100000
5000
1000000
1000000
1000000
100000
600000
100000
DESClUPTION OF OPERATIONIA..OCATIONIIYEHICLEI'IPECIAL ITEMI
1H0lLD ANY OF THE AlOYE DEIClUIED POUCIEI IE CANCELLED IEFORE THE
EllPIIATlON DATI THEJlEOF, ntE IIIUING COMPANY wu. ENDEAVOR TO MAL
3D DAYS WRITTEN NOTICE TO ntE CERTFlCATE HOI.DEII NAMED TO THE LEFT,
IUT FALUIlE TO MAL IUCH NOTICE IHALL IMPOIE NO OIUGATlON 011 Wlurv
OF ANY K"D UPON ntE COMPANY, ITS AGENTs 011 IIEPIIESENTATlVEI.
AUTHORIZED IIEPIIEIENTAT
707980000
City of Clearwater
Economic Development Dept.
P.O,Box 4748
Clearwater, Fl 34618
Attn:jPat Fernandez
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