CERTIFICATE OF LIABILITY INSURANCE (78)
Jun 09 2008 8:26AM
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ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATi (MM/D1)fYYYV)
. 5/14/2008
PRODUCER (910)509-9000 ~: (910)509-9006 THIS CI:RTlFICATE IS ISSUED AS A MAlTER OF INFORMATION
, ,.tfa1keZ' . !l'ay1oZ' Agancy, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERnFICATE DOES NOT AMEND, EXTEND OR
1430 CammonwealCh Dr~ve i302 AlTER THe COVI!!RAGE AFFORDED BY THE POLICIES BELOW.
WiJ.ainat.on ItC 28403 1N8URERS AFFORDING COVERAGE HAle"
IMSURED INSUReR A: Hartford Casual tv 29424
*K1.m& CZ'eed, Pll. INSIWR B: ~in Ci tv l'J.ra Insurance 29459
P. O. Box 806 INSURER c:
IN.URaI D:
Wilmington He 28402 INSURER e:
THE POlICIES OF INSURANCE LISTED BeLOW HAVE BEeN ISSUED TO THE INSUR&D NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOlWlTHSTANCING A~"
REQUIREMENT. TERM OR CONDrTlON OF NolV CONTRACT OR OTHEIt DOCUMENT WITH ~CT 1:0 V\IJo!I9H :rtU~ C~I."'.c:;A~ w.r"B~.lSSUEO OR MAY PERTAIN.
THJ:. .'NSURAN~.:AFFOROED "BY .THE .POLICIES .00SCRlBED ~.1S .SUBJECT TO. Au.. THE TERMS. EXOLUSIONS AhO CONDITIONS OF SUCH POLICIES.
lNSR ltoDO'L TYPE!! Of INSURANCE POLICY NUMIII!ft ~'f'~ POLICY I!XPlRATION UMITa
DATI!
.!!NEIlAl UABIUTY .rft_..~- . s 1,000,000
~ =r~IALGf;NE!!RAl. UABILI'l'Y TO REI<lTEO . S 300,000
A I-- CLAlMS MACE (j] OCCUR 22 tJt1.lIJ. aun 5/15/2008 5/1S/2009 IB-\ s 10,000
. . flDV....lllf'lV S 1,000,000
1 ............ $ 2,000,000
nLAC3GRe~UIIIIT AF11lS PEfl: . GG $ 2,000 000
.OllOY I X I ~ lnr.
~U1'OMOIILE L!ABlUTY COMBINlFo stHGLE I.IMIT 5 1,000,000
.!. ANY AUTO lEa ...a..nt)
B - AU. OWN5D AUTlJS 221lDtAMOfi84 5/15/2008 5/15/2009 BODILV INJURV
(Fer p.non) S
- SCHEt)ULED AUTOS
~ HIREO AUrOS IlODILY INJURY S
(F'W .cc:ldent)
i- NONoCWN5D AUTOS
PROPERTY DAMAGE S
(Pwr 8Clcl6enl)
::rOE LIABILITY AlJTO ONI. Y - l!A. ACCIDeNT S
. ANY AUTO arHERll-lAN Ii''''.f.N! $
AUTOONL....: Ant: *
~CESllUNIR8LI.A LI"IILITY & 10 000,000
X OCCUR CJ ClAIMS MAOE - !It 10 000,000
s
.A ~ CI!DUCTlElLE 22XWtlAOli18 S/15/2008 5/15/2009 &
X &10 000 I.
S WDRKERICClMPEN.....l1ON'lNO X I WCI!I1A'lUo I M
IiMPLOY...' UAIIIUIT
#f'( PROPRIETORIPAATNER/!XECUTIVE I ~ I 10..,... ACCIDeNT I. 1,000,000
O'FIC.ERIt.IEM.Bl!R EXC:l.UDEO? 22WBXG&fU 5/15/2008 5/15/2009 I... ~e"....., . -vecle 1.000.000
.If~ ~~aIb.uncler inc1ud!=r _eo o~:fl~ I.., "'''''U'', 's 1,000,000
cmtl!R
DElSCRlPTION Of OPERA110JoolSlL.Oc:All0NSNIHICLl8lEXCWIIDH8 ADDIlIlBYI!NIlOR8aIENT/8P!elAL PROVISIONS RECEIVED
15 al(1l noUC4I elf! canc:el1&1::Loa :for _ ~Ilt of pr-.i.am,
JUN 11 2008
E t'!4N' ELLA: OFF/"',,,,, "'.._ ~
CERTIFICATE HOLD R
(727) 5.62-4'755
CJ.ty of Clearwater
Bnqineednq Dept - Sui t:e 220
At:12I:. Dina xat:4,o1itd. "Di.~.' p"'" P , E."" f.'
P.O. Box 47.48 """L tf'''''''' ...,'... · '~: .,;
C1.a:wateZ', J'L '3317!H-4''-t ,...., ;,~ '. ..,.
'I W ... .. ''''8
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LID 1.0111 lHIi
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