CERTIFICATE OF LIABILITY INSURANCE
!l.-
CLEARCOM
Client#= 32549
~ ACD.BD.. CERTIFICATE OF LIABILITY INSURANCE
DATE IIIM1DD/YY)
11/13/02
THIS CERTIFICATE IS ISSUED AS A MAneR OF INFORNATlOr
ONLY AND CONFERS NO RIGtn"S UPON THE CEATlFlCAn
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND 01
ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOV\
PRODUCER
Starkweather & Shepley
Insurance. Inc;.
PO Box 294
Westerly, RI 02891
INSURERS AFFORDING COVERAGE
INSURERk Si"PAUL COSJUSSAlUNG
~.. . . ....
INSU.~ B;
INSURER C;
INSUAEfI D:
INsu'RED
Clearwater Community Salling Assoe, Ine
1001 Gulf Blvd.
Clearwater, Fl 33767
I INSURER E:
COVERAGES
THE POUCIES OF INSURANCE; USTEO 8ELOW HAVE BEEN ISSUED TO THE INSuRED NAMeo ABOvE FOR THE; POUCY PERIOD INOICATeD. NOTWITHSTANDI
ANY REQUIREMENT, TeRM OR CONDITION OF ANY CONTFlACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY Be ISSUe;:O
MAY PERTAIN, THe INSURANCE AFFORDED BY tHE POI.IClES DESCRIBED He~E1N IS SUBJECT TO ALL THE TERMS. exct.USIONS AND CONOITlONSOF SI,.
POUCIES. AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCE;O BY PAID ClAIMS.
~.._... TYPI5 OF1NSUAANC~-" .. I
A ~ENERAL UABILITY
>ClcoMMeAC~G~NiRALL~Lrrv
~C""~__ ~~".
~EN'L AGGRE~e 1.lMrt Af'1"L1ES PER;
-l POI.ICV I' I ~8r n LOa
AUTOMOBILE LIASIUTY
ANY AUTO
I ALL OWNED AUTOS
~ SCHeDULED AuTOS
9 HIRED AUTOS
NQN..OWNED AUTOS
I... .. -. .
I I
~RAGE LIABlUTY
l-i ANY AUTO
~CESS LIA8IUTY
r~ OCCUR 0 CLAIMS MADE
R DEDUCTIBLE
RETeNTION S
WORKSAS CCMPENSATIOtI AND
EMPLOYa=lS' LIABIUTY
POL.JCY NUMBER
390FA539200297
I~ Ii!FFiCTiVfT~ ,i.~~ .... .-. UMIT$
11/06/02 11/06/03 ~~_FlAENCE
"lfIE ~~ (Any one lire)
.!:!~.~_EXP ~ llI'lI!l poI$~). ..
PERSONAl. & NN INJURY
GENeRAl. AGGREGAlE.. >
PROOUCTS.~~MPJOp AGG
COMBINeD SINGlE LIMIT
(E.a aQCidenl)
_U' ...
BODILY INJURY
(Per pelll(l(t)
-'.-
SODIl Y INJURY
(Per 8CCli*l)
.....~$
PROPIiIUV DAMAGE '
(Per acclllenl) S
AUTO ONLY ,-, EA ACCIDENi .~ ._
EA ACe $
AGG $
S
$
..., .$.
s:
$
0TI'i1iR THAN
AUTO ONL y~
EACH OCCURReNCe:
~!!EGATi
-',
I_WCS'rATU- I IO..J",fi-.
_0"01;1.'( lJMI]'S. ...
1;.1.. eACH AC<?~!ff $
!:h- Dl:SiASE - EA EMP~oyee s
E.L DISEASE; . POLICY UMrr S
I $1,000,000
!
~ OTHERP&I
390FA539200297
11/06102
11/06103
IESCIilIPTlON OF OP&AA.'nONSlLOCATlONSlVEHlCLE!SlEXCLI.ISlONS ADDED BY ENOORsEMENTISPICIAL PROVISIONS
;erificate Holder listed below is named as Additional Insured
arnFlCATE HOLDER
l'ADDmoNALINSUIlED:INSU~R~R:
~1.,.QOO.OOO
S50..~9.Q.._
$5 000
sj,~.!l,gJOOO
$ ......
s1.0qQ,()OO _
$
$
City of Clearwater
Marine & Aviation Dept
25 Causeway Blvd.
Clearwater, FL 33767
CANCELLATION
$HOULg ANYOFTHE A80VEDESCRl8&D POLICIESBIiCANCELLED BEiFOAE'rtlE EXPIRATlOl
DATE ltlERliOF. THE ISSUIIIIG INSURfR WII.L ENDEAVOR TO MAIL 10....-. DAVSWAmE,
NOTICETO"IHE CERI'IFlCA'1'E ~At:\J"!]~1'1~.!;flil./:l.J8.f~OSOSHALL
IMPO$.NOOISI.IGATlON OA 1M &t.0) fiGs AGeNTS OJ
REPREiSEI'ffAl1VEll. At't1>mey
AUTHORIZED FlEPRe&ENrAl1VE . .
.!' ..
I
CORD 25-S (1/97) 1 of 2
#S581 06lM581 05
).-"
IMPORTANT
If the cel1ific:ate holder is an AODITrONAL INSURED, the policy(ies) must be endorsed. A statemem
on this certificate does not confer rights to the certificate holder in lieu of such endorsemem(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, cenain policies may
require an endol'$Elment. A statement on thiS certificate do" 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, f10r does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
COI=1025-S(7197)2 of 2 #SS8106/M58105