CERTIFICATE OF LIABILITY INSURANCE (2)
ACORD,. CERTIFICATE OF LIABILITY INSURANC~~t~~ M~ DATE (MM/DDIYY)
03/29/02
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wallace Welch & Willingham Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
3810 16th Street North HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 33020 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
St. Petersburg FL 33733
Phone: 727-522-7777 Fax:727-521-2902 INSURERS AFFORDING COVERAGE
INSURED INSURER A: Mental Hlth Risk Retention Grp
INSURER B: Zenith Insurance Company
f---.
Directions for Mental Health INSURER C
1437 South Belcher Rd INSURER D:
Clearwater FL 33764
I INSURER E:
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.
INSR TYPE OF INSURANCE POLICY NUMBER b~~lfMftb5WW P6>l+~~~~r6~~?N LIMITS
LTR
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
I--
A X COMMERCIAL GENERAL LIABILITY CCLOO1206 01/15/02 01/15/03 FIRE DAMAGE (Anyone fire) $ 300,000
I CLAIMS MADE D OCCUR MED EXP (Anyone person) $ 5,000
,.--
PERSONAL & ADV INJURY $1,000,000
-
GENERAL AGGREGATE $3,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3,000,000
I n'PRO- n
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $
ANY AUTO (Ea accident)
-
ALL OWNED AUTOS ! BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
I--
HIRED AUTOS BODILY INJURY
e---- $
NON-OWNED AUTOS (Per accident)
e---- -.
e---- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
=1 ANY AUTO ! EA ACC $
I OTHER THAN
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
o OCCUR D CLAIMS MADE I AGGREGATE $
$
R DEDUCTIBLE I $
RETENTION $ $
WORKERS COMPENSATION AND X I TORY LIMITS I IOJ~-
B EMPLOYERS' LIABILITY WC26013 95/01 / O~l._ ()!:i~LQ1.L O~. .U.QQJ 000
E.L. EACH ACCIDENT
.--.. - -....---- ____ n___ _,_,,_._.___,__ ___ ______c_ .--.- -- " ---~---- .,-- - -- .I--c . .. ,-- .'.
EL. DISEASE - EA EMPLOYEE $ 100,000
E.L. DISEASE - POLICY LIMIT $ 500,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATlONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICA TE HOLDER I N I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
CLWTRPO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL AL DAYS WRITTEN
Clearwater Police Dept. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Attn: Janet Skinner IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
645 Pierce Street
Clearwater FL 33756 REPRESENTATIVES.
I A\\O\\D R12RESENC
. " "- .....
ACORD 25 S (7/97)
@ACORDCORPORATION 1988