CERTIFICATE OF INSURANCE
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$ 1. OCO . 000 I
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A~IY Ont; lIersorJ or I
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!1~n a1 ^g9rc~lilte'" ....... $ 2.000.000 I
r-rrn Co.'lIP Ol!~ Aggn~9at",* . S I . (IOU. nOD I
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Ol:Currcm:e ,...... s I
IClllOp OpS/Dl sease I
;r/:!Jdte* ....... 1: ,
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STA1UrORY I IHIT5 I
L Y INJUR'1/ACCIOUH .., $ I
iy In.1ury C.Y Oil.easr. I
CH EMP' (IYEE ...... $ I
" ~.v T njUr}' hy Di SCd~e I
olley LIMIT .... ....., S I
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OESCR'IIT!ON U~ OPERATIONS/lOCAl IONS
vEHICLf s/RESTR ICTIONS/SPEC1AL nrM$
Jan-~9-05 09:4BA
f.ERTl~tCATl OF JNSURANCE
The company ind 1c.1t./~d below <:~rti ries l.hc1t the ;nSlJr.1I11'e Jt'o'::c:! :y \.:.,e [I: iCY or pt~llcir.!; numh(!relj Ilnd
dc~~crib~d b,~low i~, in (orc(! a5 of the eft(!Ctivc d,j,,(: ur ':n,~ ::i;rt.til~t/'. tli" Ccrl,fi,."lt.- llf Iosur,iT1cr
does not amend. e)(ti~nd. or' ot.herwise alLer th~ Tcrfll~ an/: Conc:lliCJf1~ (i' Ins f':ln:c C::;Vf;f'd'Je ::.o('lllinKl in uny
pol iCy nUfl,bcred and dc~crib(!d b(~low.
ormr 1r.^Tl HOLO! H:
CITY or CLEARWATER /
ATTl.NTION TO MARIF ORSfI LO
ll? S oscEOLA AVENI)I.
CLEARWATER. FL 33756
itf),:rcEO'
Cr'AR II Y W \IU;~. I NC
915 CIII:) 1.11 STR[! r
(II ,'\RItIA I . r L 3J7~)G
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I I POLICY NUM8ER I PUI iCY I no; I::Y I
I TVVE or lNSll~ANCE 1 & IS51JlNGtO. 1~t=F. DAlE lrx.... DAlE I
\ LI^{lILITY I 77 80-6'13121-3001 I (I' 13-114 I UI' 13-D~l I
I LX) liabillty <Jnd I NAflONWIUE t I 1
I MI?ai Cd 1 Exrwnse , MlI fUAL ! I
I PF.r~onal tino I lNSURANCE CO.
I Mv~\r'li S i TIC) I n.iury I
I [X] MI~<.1 i ca 1 EtIlcnses I
I (X) rin~ Legal I
I lillhilit.y I
I I
I I
III Othp.r Llability I
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I AUTl)t1OBILl UABll TTY
I [ ) 8USIN~SS AUIO
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I l ) Owned
I r ] IIi reci
I L , Non-Owned
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ILl umbrE!lla ~(Jnn
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III Worlwrs'
I COlnpen!; il t; on
I and
I I J F'mployer,,'
I liabi1lty
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Should dny of tt\e i\bov~ <1~scr'lbed polIcies lie I':l!nc:e'led beforp. lhl?
ClXplratilJo elate. the 1n~;,(ranc:e company \{ill end~Il"Il" to mil; i 14 days
,..,. i tten ntltlCe to ttle above nll~d r.crt' fic:at.e 11r,lldcr'. bl..t :<.il Illr~ l::l
lIIail sueh lIOticc stl.:t II impose no obl1!jiltinn or lil!lli11t.V II!)"" the
compi:lfly. i h ilg(lnt.~ _ or n~pr~:i(mtat i "es.
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LlHIlS OF IIABIllIY
("liMITS AI 1NCI PHON)
My
fie Occ~Jrr<?no!. .
I.,c 1 ;j~ j rl "bov(~ .
Or (ll1ililtion
ANY lNE fir I{$QN ."......... $
Any .nr. FIrE> Cll' Explll!,IOn $
I Ooel ", y 1 n.1 iJry
( ,-,r.!' Persor;) .......... f,
( ,) el, AC<:I d('!1t.)
foro crly Llamil(Je
( .let. Aec::1Cl~nt)
COl'l irlE:cl $~T19~e ~ ~mi ~
IXCESS I.lABH II Y
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P.01
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$
Effe.:tive Oat(! of l.:enlficilLe: 02-13-;)004
Date Certi rleilt.e ISSIICd: 01 19-200~
^<.ttn()f' I zed i<~:;r( ,ent~t j 'Ie:
(:OI.nt~:'~ igor:d II :
IJAVE ~ A7.ANrS AGENCY rNC
14/0 CUI ~ TO RAY BLVD
(I CAI{l.JATfR. Fl :W!i5-!i319