CERTIFICATE OF INSURANCE (2)
08/27/2004 10:12 FAX 727 725 3663
CARLISLE FIELDS & CO,
141 0021003
~CO~D",
IJAT!; (MM/DDIYY) .;,"
:jm
:11 08/27/04 ::1'
THIS CERTIFICATE IS Issueo 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
-'"
PRODUC~R
Ca~lisle Fields & Company, Inc
P.O. Box 7910
Clea~at8r FL 33758-7910
Pat A. Carlisle
PMneND. 727-797-0441 F""No.727-725-3663
INSURED
COMPANY
A Auto OwnerlOl Insura.nce Company
COMPANY
B
Clearwater Regional Chamber of
Comme~ea
P.O. BoX 2457
Clearwater FL 33757
,...~i:;,1 . 'II ~lll !Ui : ':i. "i:':'ii:;i:i!jlL l:11 :i.i:li!iI.'II;~~.::<l-,,:!i:iH;.i';";il'.'~I.:i;I..'i.' i,:.:?:11.jill~:I':;;:.( ".1 j;I/~I(';:;.;.'iii:i.11
j~ I I ~l!t W ,~ (::li)l:.(~::.u ~~~~l ~(~LI'j:j~,T~latll!t~;IoJ'ia-lrJtlrrJ~,i,.J~..~~..(.!U( ~' 'l;d~~.~fj~~~:~:.:..;lGh U~~~~!1t~:..l:.I(~E?
THIS IS TO CE:RTIFY lHA'l' THE POLICies OF INSURANCE LISTED BElOW HAVE BEeN ISSUED TO THI; INSUREO NAMED ABOV= FOR Tl-iE PO~ICY PERIOD
INDICA'I'EO. NOTWITHSTANDING ANY REQUIREMENY. TERM OR CONDITION OF ANY CON'rAACT OR Ol'HER DOCUMeNT WITH RESPECT TO WHICH THIS
ce;RTIF1CArli MAY BE IS.$UEO OR MAY PER'l'AIN. THE INSURANCE AfFORDED BY THE POLICIIO$ DESCRIBEO HEREIN IS suElJECT TO ALL THE TERMS,
EXCLUSIONS ANti CONDIl'IONS OF sUCH POLlCII';S. LIMITS SHOWN MAY HAVE BEEN FlEDUCED BY PAID CLAIMS.
c;OMPANY
C
COMPANY
D
CO TYPE OF INSURANC~ I'OUCY N...UBER POLleY EFFECTIVE POLICY EXPIRATION, u.,.ITS
lTR ClATE (MMlDDIVY) DAr, (MMlDDIYY) I
<il~NERAL LlAiIILITY BOOIL" INJURY OCC ~, 500,090
A X COMPREHENSiVE FORM 2042858403 08/01/04 08/01/05 'BODILY INJURY AGG ~' 500,000
PREMISESlQl'ERA'l'lONS I PROpERTY DAMAGE oce
I~ 100 I 000
X UNDERGROUND ~,100 ,000
EXPLOSION & COLLAPSE HAZARD PROPERTY DAMAGE AGG
X PROOUCTS/COMPLETED OPER BI & po COMBINeo OCC .,
X CONTRACTUAL BI & PO COMBINED AGG
INOEPENOENT CQNl'AAt;TORS PERSONAL INJURY AGG ~.q.O 000
X BROAD FORM PROPERTY OA/vIAGE
X PERSONAL INJURY
AUTOIl'OBILe LIABILITY aODILY INJURY
A ANY AUTO 2042858403 08/01/04 08/01/05 (Per pefi-On) ~ 500 r 000
ALL OWNED AUTOS (Prlvale 1"11$$) BoDILY INJURY
ALL OWNED AUTOS 1500,000
(Olher loon Pri~ale Pw;"enger) (Plil( 8Cl;!donI)
X HIRED AUTOS
X NON.OWNED AUTOS PROPERTY DAMAGE . $ 100,000
GARAGE I.IABIUTY
EXCESS UAalllTY
A X UMeRELLA FORM
OTHEr< UlAN UMBRELLA FORM
WORKERS COIliPI!NSATION AND
IlIl/lPLOYERS'I.IABIUTY
4346391200
08/01/04
OB/Ol/05
s 2 r 000 000
$~,OOO,OOO
$10,000
OTH- 'I:.'., I j;"j:,)j;. i!i#ilf,ia{'.;;".":!!I~~'1
. R ~." ,:."::/,,:~i ('V:":'.~~. /.... . 'i;'J,~f~JH:~ .\.'1.9~).
$
t
.,-.-..-'--
$
THE PROPRIETOR! INCL
PI\RTNeRSlEXEcu'l'IVE
O~FICIORS ARE: EXCL
OTHER
DIi$CRlPTIoIII OF OPI;RATlONSlLoeATlONSI'IIiHICLE5/$PI!C\Al fl'EM$
CITY005
C:i.ty Of Clea.rwater
100 S_ Myrtle Ave.
Clearwater ~ 33758
~~/27/2004 10:12 FAX 727 725 3663
CARLISLE FIELDS & CO.
III 003/003
AC-ORD..
OAT~ (MMlOOIYY) . (!>
g
08/27/041:'::
THIS CERTIFICATE IS ISSUEO AS A MATTER OF INF=ORMATION
ONL.Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CErlTIFICATE DOES NOT AMEND, EXTEND Orl
AlTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
~1/'_m.,d""'~1 RllfRlllW---"'-!IJ
PRODuceR
Carlisle Fields & Company, XnC
P.O. Box 7910
Clearwater FL 33758-7910
Pat A. Carlisle
PhonaNo. 727-797-0441 Fax No. 727-725-3663
INSURJl:P
COMPANY
/II. Auto Owners Insurance Company
COMPANY
B
"-.-' --- ---.
Clearwater ~eqional chamber of
Commerce
P.O. Box 2457
Clearwater Flo
COMPANY
C
COMPANY
o
. 'Wjl . ,! 1~~BI~'1!t.,i~~~1Ilp~::';!~Jij~~i~~jillilifr;h:;:!iii~ii~i:!i;!':i ,~iiirj~;i:i;;!II!i!,!Wj~ii:;iV!!r.ii.iiUi)i.::;:'::liiW!i:;;I
nilslS TO CE:RTlFY THA1" THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEfoIISSUED 1"0 THE INSURe!) NAMED ABOVE FO~ T~': POLICY ~eA~~'D"'" .". -. _'m .m ,",."" . ."..,," ,,"<'
INOICAiE:D, NOiWlTHSTANDINC ANY REOUIREMEN't. Tl:RM OR CONDmON OF AN'( coN'I'RACT ~ O'l'HER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICAlE MAY BE IssUED OR MAY PERTAIN. TloIE INSURANCE AFFORDED BY 'tHe POLICIES DESCRIBED HeREIN IS 5U8J5CT TO ALL T~II= 1ERMS,
EXCLUSIONS AND CONDITIONS OF SUCH poLICIES. ~IMITS sHOWN MAY HAve BEEN REDUCED BY PAlO CLAIMS.
CO
LTR
TYPE OF INSURANCE
pOlICY NUMSlER
POUCY EFFECTIVJl: I'(IUCY EXPlAA TION I
DA'I'E (UM/DDIn') DATE (u,./ODNY)
L1MIT5
A
GENE;RAL LlAIlluTY
X CoMPREHENSIVE FORM
PRl!MlSESlOPERAl'lONS
X ~~E~~S2~Jb~SE HAZARD
X PRODUCTSICOMPLETED oPE:l'l
X c;ONTRACilJAl.
INDEPENDeNi CONTRACrO/Ul
X BROAD FORM PROPERlY DAMAGE
X PERSONAL INJURY
AUTOMOBLLE: LIABILITY
Ar-rfAUTO
ALL OWNED AUTOS (Privalt!t pSli)
Al.~ OWNE:O AUTOS
(Olhar Ihsn Prival~ i>B88engBI')
X HI~eD AUlOS
X NON-OWNED AUTOS
GARAGE: LIABILllY
20421358403
08/01/04
08/01/05
I BODILY INJURY OCC
I ~DIL Y INJURy AGG
p~OPERlY DAMAGE OCC
PRopERTy DAMAGE AG(o
91 8. PO COMBINeO OCC
BI II. I'D COMBINE:O AGG ~;
PERSONAL INJURY AGG I l 500 , 000
--4=-'-
l,_500,000
Ii 500,000
:,100,000
~..100 / 000
A
2042858403
08/01/04
08/01/05
BoOI~ Y INJURY
(Per por,;on)
BODILY INJURY
(PQr aa:idllnl)
1.500,000
r $ 500,000
p~OpERTV DAMAGE
s 100,000
BOOILY INJURY &
PROPERlY DAMAGE
COMBINED
s
I5XCUS UAEIIUlY
A X UMBRELLA FORM
OTI-IER'tHAN UMBRELLA FoRM
WORKERS eOMPEKliATION AND
~MPLOYERS' UABILI'N
4346391200
08/01/04
08/01/05
$2,000,000
$2,000,900
$ 10 000
THE PROPRIETOR! INCL
PARTNERs/EXecUTIVE
Ol"FICeRS ME; EXCL
OTtU;R
DESCRIPTION OF oPERATIONS/LOCAlIONS/VEHICLYlSP"'IAL 1TEM5
Location: Beach Visitor InforJPat.ion Cente~. cert.ificat.e holder is an
Addi tional Insured, as their int.&rest may apply.
CITYOOS
City of Clea~ater
100 S. MYrtle Ave.
Clearwater F.L 33758