CERTIFICATE OF LIABILITY INSURANCE (6)
04/17/03 15:03 To:Susan Stephenson
From:Andrea Bennett
CLW
Page 2/3
ACORD 1M
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYI
04117103
THIS CERTIFICATE IS ISSUED AS A MATTER 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.
'RODUCER
ACORDIA EAST - T AMPA BAY
P.O, Box 31666
Tampa. FL 33631-3666
727-796-6666
INSURERS AFFORDING COVERAGE
NSURED
Carlouel Homeowners Assoc.
IN:,;UH~H A,
II~:,:UH~H ci,
1~lmJnrn c'
AUTO OWNERS-09703
p, 0, BOX 3442
CLEARVVATER FL 33767
IN:,:UHcH L:"
II~:,;UH~H ~,
:OVERAGES
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,
~SR ~~~~~J~~g}~~~ Pgk~EY'~'1v':!~~J.)~~
.TR TYPE OF INSURANCE POLICY NUMBER LIMITS
A ~ERAL LIABILITY 201150611103 5/09/03 5/09/011 ~ACH UCCUHH~i~C~ .~ 1000000
X e:CIMMrnCIAI cnlrnAI I IArJIIITV r1nr rlAMACir (AI"IV MIl"': rwr:) " 50000
I UAIIW,: IVIAL:I~ W IJIXUH MI:U t:,l(p (AIl1J I.\I\~ pl:lll:i~\n) ,~ 5000
- I '~H:,;I)i~AL ,~, AUV INJUHY * 1000000
lTNrnAI AccnrCATr , 1000000
"
(J~i~'L NJ(JH~(jAI~ L1MII AI'I'LI~::; I'~H, IlH()L'!UC: I ~:; - C()MI )/1)1> ^(!J(j .~
4 111')L1"OY -H IIH~)~ . n'L('/i:
- -' ,lrf..T --
~TOMOElILE LIAElILlTY cnMnl~lm :,I~ICil r liMIT "
ANY AUIO (I:~ 1:I1';I.;idi':1nLJ
I--
I-- ALL I)WN~l) AU II):,; nnDII Y IM,IiJnY
(.
,;C:llrDiJl rD AiJTn,; (F'r:f pr.rr.nn)
I-- HIH~L) AU I (.'I:,; ciUUILY II~JUHY
<,
(Ill:lr l::I/";l.;idl:lllL) "
I-- NI)I~.I)Wi~~L:1 AU II):,:
pnClprnTV DAMACir (.
(Il~r l:Il":l..:jl.l~I\L)
nRAGE LIABILITY AU I (.'I I)I~LY . ~A NXIL)~I~ I *
ANV ALJTc'\ cm Irn TIIAN rA ACC: "
AU I U Ui~LY, ^(~(3 .~
EXCESS LIABILITY ~N_;H I)IXUHH~NC~ .~
n-CJcC:LJn n CI AIMC;MAnr A(iCnrCiA Tr (.
<,
"
R LlcL)UI_: IlciL~ .~
nrTr~ITIc.\~1 ',' "
WORKERS COMPENSATION AND I (I~;~~; L.WiI'J;:; I I'\~K'
EMPLOYERS' LIAElILITY
~,L, ~N_;H NXIl:J~i~ I ,~
rl m,r A:T r A rMPII.".1','rr ,
"
~,L, L)I:,;~A::;~ - I'ULICY LIMII .~
OTHER
JESCRIPTlON OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
ATTN: SUSAN STEPHENSON - FAX tf727-562-4086
PROPERTY LOCATION: 1 CARLOUEL SUBDIVISION, CLEARWATER, FLORIDA
CERTIFICATE HOLDER I X I ADDITIONAL INSURED: INSURER LETTER: CANCELLATION
CITY OF CLEARWATER SHOULD ANY OF THE AElOVE DESCRIElED POLICIES ElE CANCELLED ElEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ 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 OElLIGATION OR L1AEliLITY OF ANY I<lND UPON THE INSURER, ITS AGENTS OR
CLEARVVATER, FL 33758 REPRESE TIVES, I
AUTH ,~~...
I
~CORD 25-$ (7/97)
46- 64
@ACORD CORPORATION 1988
04/17/03 16:03 To:Susan Stephenson
From:Andrea Bennett
CLW
Page 3/3
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).
DISCLAIMER
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,
l\CORD 25-$ (7/97)