CERTIFICATE OF INSURANCE
ACORD.
CERTIFICATE OF LIABILITY INSURANCE
OP ID DATE (MMlDDNYVY)
CONSCRE 04 16 04
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
PRODUCER
Hatcher Insurance, Inc.
P.O. Box 540689
Orlando FL 32854-0689
Phone:407-841-2686 Fax: 407-841-2688
INSURED ~AI,' ~/~Y
CCCS of Central Florida &
The Florida Gulf Coast, Inc
P. O. Box 4963
Orlando FL 32802-4963
INSURERS AFFORDING COVERAGE
NAIC#
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
U.S. Fidelit & Guarant
Certain Underwriters at Llo
United National Insurance C
Hartford Insurance Compan
American Home Assurance Co.
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR NSRi TYPE OF INSURANCE POLICY NUMBER I rD'A'TE iMMIOlijWj DATE (MMlDDNYI LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
- 09/25/03 09/25/04 I PREMiSES (Ea occurence)
A ~ COMMERCIAL GENERAL LIABILITY BK01486286 $ 300000
=:J CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $ 10000
I---
PERSONAL & ADV INJURY $ 1000000
GENERAL AGGREGATE $ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2000000
I POLICY n j~g: n LOC Emp Ben. 1000000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000
- 09/25/03 09/25/04 (Ea accident)
A ANY AUTO BK01486286
-
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AUTOS
-
~ HIRED AUTOS BODILY INJURY
(Per accident) $
~ NON-OWNED AUTOS
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESs/UMBRELLA LIABILITY EACH OCCURRENCE $ 1000000
C ~ OCCUR D CLAIMS MADE FSUOOOO167 09/25/03 09/25/04 AGGREGATE $ 1000000
$
~ DEDUCTIBLE $
X RETENTION $10,000 $
WORKERS COMPENSATION AND X/TORY lIMm3 I IUJ~-
E EMPLOYERS' LIABILITY WC7252599 01/01/04 01/01/05 E.l. EACH ACCIDENT $ 100000
ANY PROPRIETOR/PARTNERlEXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L. :):SEASE - EA EMPLOYEE ~ 100000
If yes, describe under E.L. DISEASE - POLICY LIMIT $ 500000
SPECIAL PROVISIONS below
OTHER
B Prof Liability 1004-00059343A 10/01/03 10/01/04 Prof Liab 1000000
D Directors & Off OAOO02120 10/28/03 10/28/04 Dir & Off 2000000
'ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
'04 APR 19 PM12:43
:ERTIFICATE HOLDER
CANCELLATION
CITYCLE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
City of Clearwater
Attn: Marie Orsello
112 S. Osceola Ave
Clearwater FL 33756
.~~
@ ACORD CORPORATION 1
CORD 25 (2001/08)