CERTIFICATE OF LIABILITY INSURANCE
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THIS CERTIFICATE IS I~UED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
PRODUCER
Carlisle Fields & Company, Inc
P.O. Box 7910
Clearwater FL 33758-7910
Pat A. Carlisle
Phone No. 727-797-0441 FaxNo.727-725-3663
INSURED
COMPANY
A
Auto OWners Insurance Company
$
$
$
IOJ~.t==
$
EL DISEASE. POLICY LIMIT $
EL DISEASE - EA EMPLOYEE $
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
~ DAYS WRmEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAlL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED ~P1pr:IVE 11 ( ~ ~ .
..>~/1':. ..L~RATlON1988
COMPANY
B
Clearwater Regional
Commerce
P.O. Box 2457
Clearwater FL 33757
:t;OV~~GES:::::::::':':" ........................... ......
Chamber of
COMPANY
C
COMPANY
D
.................. .
......... .
........ .
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DDIYY) DATE (MM/DDIYY)
TYPE OF INSURANCE
POLICY NUMBER
A
GENERAL LIABILITY
-
X COMPREHENSIVE FORM
-
BODILY INJURY OCC
BODILY INJURY AGG
PROPERTY DAMAGE OCC
PROPERTY DAMAGE AGG
BI & PO COMBINED OCC
BI & PD COMBINED AGG
PERSONAL INJURY AGG
2042858403
08/01/03
08/01/04
PREMISEs/OPERATIONS
UNDERGROUND
EXPLOSION & COLLAPSE HAZARD
PRODUCTS/COMPLETED OPER
-
X
-
~
X CONTRACTUAL
-
INDEPENDENT CONTRACTORS
-
X BROAD FORM PROPERTY DAMAGE
-
X PERSONAL INJURY
AUTOMOBILE LIABILITY
-
08/01/03
08/01/04
BODILY INJURY
(Per person)
A
2042858403
ANY AUTO
-
ALL OWNED AUTOS (Private Pass)
- ALL OWNED AUTOS
_ (Other than Privete Passenger)
X HIRED AUTOS
-
X NON-OWNED AUTOS
-
GARAGE LIABILITY
-
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
BODILY INJURY &
PROPERTY DAMAGE
COMBINED
EXCESS LIABILITY
I UMBRELLA FORM
I OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
EACH OCCURRENCE
AGGREGATE
IWC STATU- I
TORY LIMITS
EL EACH ACCIDENT
THE PROPRIETOR!
PARTNERSIEXECUTIVE
OFFICERS ARE:
_ QTH_EIL......c.__
RINCL
EXCL
.............
- 00.
... .
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
Location: Beach Visitor Information Center. Certificate holder is an
Additional Insured, as their interest may apply.
: C:eRT:IFICATE: :IiQU)EFt:
. . . . ........::CANCELLATION:>
.................. .
CITY005
City of Clearwater
100 s. Myrtle Ave.
Clearwater FL 33758
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LIMITS
$500,000
$500,000
$100,000
$100,000
$
$
$ 500,000
$500,000
$500,000
$100,000
$