CERTIFICATE OF LIABILITY INSURANCE (4)
SENT BY.: GBB;
.....
NOV-3-0410:07;
LEARCOMMU
ACORD", CERTIFICATE OF LIABILITY INSURANCE
...-~-:;.-
860 399 3696 j
PAGE 1/2
Clif)nt#: 13438
PR<lDUCER
Gowrl8, Barden & Brett, Inc.
70 Essex Road
WestbroOk,CT 06498
660 399-5945
INSURED
OATEjMMIDDlYYYYJ
11/03/04
mls CERTIFICATE IS ISSUED AS A MATTEI'{ OF INfORMATION
ONLY AND CONFERS NO RJGHTS UPON lHE CERtlFICA rf
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
At."fER THE COVERAGE AFFQRDED BY THE POLICIES BELOW.
Clearwater Community Salling Assoc.,lnc
1001 Gulf Blvd.
Clearwater, FL 33767
INSURERS AFFORDING COVERAGE
INSURER A: Federal Insurance Company
INSURER B:
INSURER c.
INSURER 0:
INSURER E:
filA/eN
20281
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATEO. NOTWITHSTANDING
ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMENT WITH REsPECT TO WHICH THIS CERTlf'ICArE MAY BE ISSUED OR
MAY PERTAIN. THE INSUAANCE AFFORDEO flY THE POLICIES DESCRIBED I'IEREIN IS Sl.JGJI;;CT TO ALL THE TERMS. E')(C!.USIONS ANO CONDITIONS OF SUCH
POLICIES. AGGREGA.TE LIMITS SHOWN MAY HAVE sEEN REDUCED BY PAID CLAIMS.
= TYPE OF INSURANCE f'OUCY NUMBK" . PJMYU'a&W~ PoUC;Y EXP~ ~IMiitl
A X GENERAL UABILlTY 35823516EZG 11/06104 11/06105 EACH OCCURRENCE $1,000000
I-- UAMAGE TO RENfED
X COMM~RC~lGENERALl~8UTY $1 000 000
I Cl.AIMS MADE [iJ OCCUR MED E;l;P (Anyone person) $10 000
>-- PERSONAl & ArN INJURY 51 000 000
GEN~RALAGGREGATE $2,000 000
f--
~'l. AGGREnE UMIT APnS J'ER: PRODUCT3 . COMP/OF' ilGG $lncludsd
POUCY P,~T LOC
~UTCMoellE UABILITY COMBINED SINGLE LIMIT I ~
ANY AUTO {Co llCCidel'\tl
f--
f-- AU. OWNED AUTOS aool!. Y INJURV
IPer pelSgnl $
f-- SCHEDULED AUTOS ...."'.................-
~ HIRED AUTOS BODilY IIIJURV
(Per ~(hid~nl) $
- NON.OWNEO AUTOS
~ '" --' PROPERTY DAMAGE
(Por ..~dd;n1) $
~RAGE LtABlUlY AUTO ONL V - fA ACCIDENT $
ANY AUTO OlliER llIAN EA ACC S
AI)To ONL V AGG ~
...............,.,...,....-
EXCESSJUM8Rl!LUI LIABIUTY ~CH OCCURRENCE: $
=:J OCCUR 0 CLAIMS MADE AGGREG/\ Te S
S .
=1 Df.DUCTIBlE S
-
RETEN'JION 5 $
WORK~RS COMPENSATION AND -T ,.~~yS,T~I'\!~ IOJbi"
EMPLOYERS' L1ABllfh' -
:,\ ANY' PROPRIETORlPARlNERJeJCECUTIVE EL. EACH ACCIDENT $
OFFICFRlMEMBER EXClUDED? F.1.. DISEAS", . EA EMPlOYEI $
U~~lir~WJv~~ ~aN EL. DISEASE - POLICy UMIT $
OTN~R
-
DESCRlP110N OF OPERATIONS' LOCAllON$ {VEHICLES I EXCLUSIONS ADDED IY Iii!lDOllSEIIolENT I SPECIAL PROVISIONS
The City of Clearwater is named as Additional Insured u respects General
Liability only.
City of Clearwater
25 Causeway Boulevard
Indian Roc;ks eeach, FL 33767
CANCELLATION
SHOUlD ANY OF THE ABOVE D!SCRlBED pouc,es 8E CANCELLiEO IJliiFORE THE I!Xf'lRAllOfll
DATI! THEREOF, THE ISSUING INSURER WILL etlDIl.wOR TO MAil _.i,i'L DAYS WIU1TEN
NOTICE TO THE CERTlFICAn HOLDER NAMED TOTti!; LEFT. SUT FAI~URli TO DO SO SHAU.
IMPOSE NO OBUliAl1 OR UAelLITV OF AN\' KIND U tI THE INSUREI'!. 1'1$ At>.IENTS OR
CERTIFICATE HOLDER
..
ACORD a, (2001/08) 1 of 2
tlS13965/M 13964
OHS
--
@ ACORD COf~PORATION 1988
SENT BY: GBB;
.';- '.,wr
sao 3M 369B;
NOV-3-0'4 10:07;
PAGE 2/2
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be andon,ed. 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 ofthe policy. certain pOlicies ma~1
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. rElverse side of this form does not constitute a contract bellJ\ieen
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 25-9 (2001/08) 2 of 2
tlS139$5/M13984