CERTIFICATE OF LIABILITY INSURANCE (3)
A CORDm CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYI
05/07/02
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ACORDIA EAST - TAMPA BAY 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.
Tampa, FL 33631-3666
727-796-6666 INSURERS AFFORDING COVERAGE
INSURED INSURER A: AUTO OWNERS-09703
Carlouel Homeowners Assoc.
p, 0, BOX 3442 INSURER B:
CLEARWATER FL 33767 INSURER c:
INSURER D:
I 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.
INSR TYPE OF INSURANCE POLICY NUMBER ~~~gYJ~5~~"~ "gk!fl,~~J~J.J$~ LIMITS
LTR
A ~~ERAL LIABILITY 2045061402 5/09/02 5/09/03 EACH OCCURRENCE $ 1000000
~MMERCIAL GENERAL LIABILITY ----,----- FIRE DAMAGE (Anyone fire) $ 50000
" CLAIMS MADE W OCCUR ~. ..
M ED EXP (Anyone person) $ 5000 ----~
H PERSONAL & ADV INJURY $ 1000000
u-- GENERAL AGGREGATE $ 1000000
n'L AGGREA LIMIT APn PER: PRODUCTS - COMP/OP AGG $
POLICY ~~gi- LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
~
- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
-
f-- HIRED AUTOS BODILY INJURY
$
NON-OWNED AUTOS iPar accident)
'--
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY, EA ACCIDENT $
! ANY AUTO OTHER THAN EA ACC $
~---1
I , AUTO ONLY: AGG $
I
EXCESS LIABILITY EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AGGREGATE $
b DEDUCTIBLE $
$
i I RETENTION $ $
. L WORKERS COMPENSATION AIIlD ,JtC STATU- I IOTH-
,-- I- - - " TQflY L1Nl~ ER ---.-
f EMPIOYERSrUABfLlTY" .~-- E.L EACH ACCIDENT $
I E.L DISEASE - EA EMPLOYEE $
I
I E.L. DISEASE - POLICY LIMIT $
, OTHER
i
I
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS f-i C: ~-I \' ,..- ~",
ATTN: SUSAN STEPHENSON - FAX #727-562-4086 'i'" L:.,j
PROPERTY LOCATION: 1 CARLOUEL SUBDIVISION. CLEARWATER. FLORIDA MLW Od
R I is:< f,' ,\" !{:~ C "1;::'
CERTIFICATE HOLDER I X I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF CLEARWATER DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL .-1Q. DAYS WRITTEN
RISK MANAGEMENT DEPARTMENT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL
P.O. BOX 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
CLEARWATER, FL 33758 REPRESE~ATIVES. J
AUTH A~~A
'-"" ~ '-VI I .. -
I
T
ACORD 25-5 (7/97)
46-73
@ACORD CORPORATION 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).
'D1SCLAiMER
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)