CERTIFICATE OF LIABILITY INSURANCE (4)
MAY-~7-02 09:25 FROM:JIM HARPER
ACORDIA 7277917356
TO:727 562 4086
PAGE: 001/002
ACORD... CERTIFICATE OF LIABILITY INSURANCE , I DATE IMM/DDIYYI
05/07/02
PROOVCEA THIS CERTIFICATE IS ISSUED AS Jf.MATTER OF INFORMATION
ACaRDIA EAST - TAMPA BAY ONLY AND CONFERS NO RIGHTS, UPON THE CERTIFtCATE
P.o. Box 31666 HOLDER. THIS CERTIFICATE ~OES NOT AMEND, EXTEND OR
Tampa, FL 33631-3666 AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
727-796-6666 INSURERS AFFORDING COVERAGE
-.. .
INSURED Carlouel Homeowners Assoc. INSURER A: AUTO DWNERS-09703
P. O. BOX 3442 INSUI'lER Il:
CLEAAWA TER FL 33767 INSuREA c:
..
INSURER 0; -.--
INSURER E:
COVERAGES
THE POLICIe;s OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INsuRED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REaUIREMENT. TERM OR CONDITION OF ANY CONTRAcr OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY OE ISSUED OR
MAY PE!RTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HER!:IN IS SUBJECT iO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TriiSif r' . ~lf.y liFF~CTlVE POUCV EXPiRAT1~~ ,
'lTR' TYPE OF INSURANCE POLICY NUMBEJI D Y UMITS
A ~NERAL LIABIUTV 2045061402 5/09/02 5/09/03 EACH OCCURReNC~ e 1000000
X COMMEACIA\, GEN~RAL LIABIUTY FIRE DAMAGE (Any ana.!I'." ~ 50000
I CLAIMS MADE [i] OCCUR M~D EXP IAn~ on. Il4lrsonl $ 5000
PERSONAL & ADV INJURY ~ lO~OOOO
f- . -
G~NERALAGGReGATE e 1.0OOO~~_
f-- .-
GEN'L AGGREn UMlf AF'n PER: PRODUCTS - COMP/OF' AGG $
I POLICY ~'.2~ LOC .
~TOMOBILE UABIUTY COMBINEO $INGLE LIMIT I
AI'lV AUTO IE~ acoid.nt)
- ,
-- ALL OWNED AUTOS BODILY INJURY I
SCHEDULeO AUTOS IPo, persanl
- ,,-
I-- HIRED AUTOS ElOOll Y INJURY
'Per .c~.~.n!1 e
I-~ NON-OWNED AUTOS -
f-- -- PROPERTY DAMAGE e
(F'8' ~~cid.n!l
GARAGE UAlllLlTY AUTO ONL V. EA ACCIDENT $ .-
R ",:.IV ",UTO OTHEl'l TIotAN Ell. ACC $
AUTO O:.lL'I': AGIO ~
Ell CESS UA Ell LITV EACH OCCURRENCe e
r::r OCCI,IR 0 CLAIMS MADE AGGREGATE $
.
$
=1 DEDUCTIBLe s
.' .-
RETENTION e $
I ~~.:rATU-; I IOl~-
WORKERS COMPENSA"'ON AND IMITS
EMP~OVERS' UABILI1''' EL EACH ACCIDENT ~
- --
EL DISEASE -, EA eMPLOYEE $
e,L DISEASE - POLICY LIMli S
OTKS!
DESCRIPTION OF OPERATIONSILOCATIONS!VEHICLeSIEXCLUSIOHS ADDED IV ENDORSEMENTISPl:CIAL PROVISIONS
ATTN: SUSAN STEPHENSON. FAX 1727-562-4086
PROPERTY LOCATION: 1 CAALOUEL SUBDIVISION, CLEARWATER. FLORIDA
CERTIFICATE HOL.DER I X I APDITIONAL INSURED; I'lSUIlEA LETTEA: CANCELLATION
SHOULD ANY OF THE AElOVE OESCRlBED POUCIE$ BE CANCELLED BEFORE 1'HE EXPIRA1'.ON
CITY OF ClEARWA TEA DATe THEREOF, THE ISSU1NClINSURfR WILL ENpEAVOR TO MAlL -1.Q.. DAVS WRITTEN
RISK MANAGEMENT DEPARTMENT NOTlC~ TO THE CERTIFICATE HOLDeI' NAMED TO THE LEFT. BUT FAILURE TO DO so SHALL
P.O, BOX 4748 IMPOSE 1\10 OBUlJA1'ION OR LIABrUTY OF ANY KINl) UPON TtiE lIilSUREII. IT$ AGENTS OR
CLEARWATER, FL 33758 REPRESElVAl'IVES, I
AUTII A1l- f:t7'''' ,
~.... - 'I -i , ...
I
ACORD Z5-S (7/97)
46- 73
/0 .ACORD CORPORATION 1988
i) (\-- '-'!':? . /) 0
'\...1 c.,..:,),..' u"
MAY-~7-02 09:26 FROM:JIM HARPER
ACORDIA 7277917356
TO:727 562 4086
PAGE: 002/002
IMPORT ANT
If the certificate holder is an ADDITIONAL INSURED, the policy(iesl must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsem~ntlsl.
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 endorsementls).
DISCLAIMER
The Csrtificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and ths certificate holder. nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies 'Usted thereon.
ACORD 25-5 (7/971