CERTIFICATE OF LIABILITY INSURANCE (8)
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE CMM/DDIYYI
05104104
PRODUCER THIS CERTIFfCATE IS ISSUED AS A MATTER OF INFORMATION
ACORDIA EAST - TAMPA BAY ONL Y 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 DWNERS-09703
Carlouel Homeowners Assoc.
P. O. BOX 3442 INSURER B:
CLEARWA TER FL 33767 INSURER c:
INSURER D:
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 DESCRIBE[) HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Il"'~: TYPE OF INSURANCE POLICY NUMBER ':.l1.~Y EFFECTIVE PRk!fl EXPIRATION L1M ITS
A ~NERAL LIABILITY 2046061404 5/09/04 6/09/05 EACH OCCURRENCE $ 1000000
..x. ~MERCIAL GENERAL LIABILITY I FIRE DAMAGE IAny one rl,.' $ 50000
- CLAIMS MADE W OCCUR MED EXP {Anyone person) $ 5000
PERSONAL & ADV INJURY $ 1000000 ;
-
GENERAL AGGREGATE $ 1000000 I
~'L AGGREn LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ I
POLICY P,~~~ n LOC 1
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT I
$ I
ANY AUTO lEe eccldenll
-
f-- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Pe, person)
f---
- HIRED AUTOS BODILY INJURY
$
NON.OWNED AUTOS (Po, accidonll
~
PROPERTY DAMAGE $ I
(Po, accident) I
qRAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC ,
AUTO ONLY: AGG ,
EXCESS LIABILITY EACH OCCURRENCE ,
~ OCCUR D CLAIMS MADE AGGREGATE ,
$ ,
rl DEDUCTIBLE ,
RETENTION . $ I
WORKERS COMPENSATION AND I '-';~,ST~J,l;!c T TOJgH-
TO Y I IS
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT $
E.L. DISEASE. EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $ i
OTHER
,
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENrISPECIAL PROVISIONS
ATTN: SUSAN STEPHENSON - FAX #727-562-4086
PROPERTY LOCATION: 1 CARLOUEL SUBDIVISION, CLEARWATER, FLORIDA
CERTIFICATE HOLDER I X I ADDITIONAL INSURED; INSURER LElTER: CANCELLATION
CITY OFCLEARWA TER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -1.Q.. DAYS WRITTEN
RISK MANAGEMENT DEPARTMENT NOTICE TO THE CEIlTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILUIlE TO DO SO SHALL
P.O. BOX 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
CLEARWATER, Fl33758 IlEPRESEIVATlVES. J
AUTH A1l:..1fltI
I c.- "K.I . ....
ACORD 25-S (7/971
46-38
@ACORD CORPORATION 1988
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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-S (7/97)
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