CERTIFICATE OF LIABILITY INSURANCE (7)
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE {MMIDDIYYI
04/17/03
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. O. BOX 3442 INSURER B:
CLEARWATER FL 33767 INSURER c:
INSURER 0:
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 '::i~Y EFFECTIVE POLICY EXPIRATION LIMITS
LTR
A GENERAL LIABILITY 2045061403 5/09/03 5/09/04 EACH OCCURRENCE $ 1000000
-
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ 50000
- ...1 GlAlMS MADE-U~JOCCUR .' - - - - C2:____- __-_~___ - M ED EXP (Anyone person) $ 5000
'- '-
PERSONAL & ADV INJURY $ 1000000
-
GENERAL AGGREGATE $ 1000000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG $
n POLICY n j~T n LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
I-- $
ANY AUTO (Ea accident)
I---
ALL OWNED AUTOS BODILY INJURY
I-- $
SCHEDULED AUTOS Wer person)
I---
HIRED AUTOS BODILY INJURY
!-- $
NON-OWNED AUTOS (Per accident)
-
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
==1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
o OCCUR D CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I WC STATU-.I IOTH-
TORY LIMITS ER
EMPLOYERS' LIABILITY
E,L. EACH ACCIDENT $
- - - - CC"
- E.L. DISEASE.EA EMPLOYEE. $
E.L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS HI::CEIVED
A TTN: SUSAN STEPHENSON - FAX #727-562-4086
PROPERTY LOCATION: 1 CARLOUEL SUBDIVISION, CLEARWATER, FLORIDA APR 2 1 '?n03
RISK MANAGEMENT
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 REPRESEI\t.ATIVES. J.
AUT~A~~A,..-
-
I
ACORD 25-S 17/971 ^ C ~A r\ I _ / 46- 64
V 12 1Q, IN {TL: t. -/ ~U! (LtC
@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).
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.
ACORD 25-5 (7/97)