CERTIFICATE OF LIABLITY INSURANCE
ACORD~ CERTIFICA TE OF LIABILITY INSURANC~~t~~ wj DATE (MM/DDIYY)
0.3/0.1/0.2
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 330.20. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
St. Petersburg FL 33733
Phone:727~522-7777 Fax:727-521-29D2 INSURERS AFFORDING COVERAGE
INSURED INSURER A: Mental Hlth Risk Retention Grp ,
INSURER B Zenith Insurance Company
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.
I~~~ TYPE OF INSURANCE POLICY NUMBER POLI?~ EFFECT~YE Pg,}+~~~~r~~J}?N LIMITS
DATE MM/DDIYY
GENERAL LIABILITY EACH OCCURRENCE $1,0.0.0.,0.0.0.
I--
A ~ COMMERCIAL GENERAL LIABILITY CCLDD12D6 0.1/15/0.2 0.1/15/0.3 FIRE DAMAGE (Anyone fire) $ 30.0. , 0.0.0.
I CLAIMSMADE DOCCUR MED EXP (Anyone person) $ 5,0.0.0.
PERSONAL & ADV INJURY $1,0.0.0.,0.0.0.
I--
GENERAL AGGREGATE $3,0.0.0.,0.0.0.
GEN'LAGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $3,0.0.0.,0.0.0.
h .nPRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $
ANY AUTO (Ea accident)
-
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
HIRED AUTOS BODILY INJURY
- $
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
=] ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X I TORY LIMITS I IUER'-
,.B, EMPLOYERS' LIABILITY WC2.61l13._ ......0.5/01 j O~ .0.5/0.1/0.2 $,1-0.0.,.0.0.0..-
- --- -'".---- '- ~-----"_._-- -.-_.-----,,--",- .- .._.---~ --",'-- .---", EL.EACHACC!DENT. ",..___.., ~.-
EL. DISEASE - EA EMPLOYEE $ 10.0.,0.0.0.
E.L. DISEASE - POLICY LIMIT $ 50.0.,0.0.0.
OTHER
DESCRIPTION OF OPERATIONS/LOCATlONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER I N I ADDITIONAL INSURED; INSURER LETTER: CANCELLA TION
CLWTRPO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
Clearwater Police Dept. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Attn: Janet Skinner
645 Pierce Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS o~
Clearwater FL 33756 REPRESENTATIVES,
I A\\O~D RliRESENC
ACORD 25-5 7/97 'Y " -
@ACORDCORPORATION 1988