CERTIFICATE OF INSURANCE
.. ACJ!8D~ : CE:~tlf='lCAt,:OF= LIAelL.ltyINSl.t~"\<^.:IC~~i~St:::"< DATE (MMlDDIYY)
. . .................. . .. .... . .... . ..... ...........
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PRODl:,;;R ~ THIS CERTIFICATE IS IS~JED AS A MATTER OF INFORMATION
The Connelly Insurance Group ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
630 Chestnut Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 2456 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater FL 33757,..2456 COMPANIES AFFORDING COVERAGE
Maureen Connelly, CIC COMPANY
A Cincinnati Insurance Co
Phone No. 727-461-6044 Fax No. 727-442-7695
INSURED COMPANY
B Hartford Insurance Group
Lee Arnold & Associates
cilia Colliers Arnold COMPANY
Arnold Brown Properties C Hartford Fire Insurance Co.
121 North Osceola Avenue COMPANY
Clearwater FL 33755 D
:.~Y.V." .,..: ::.....
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE (MMlDDIYY) DATE (MM/DDIYY)
~NERAL LIABILITY GENERAL AGGREGATE $ Unlimi ted
A == COMMERCIAL GENERAL LIABILITY CPP0710364 11/01/00 11/01/01 PRODUCTS - COMP/OP AGG $2,000,000
tJ CLAIMS MADE [!] OCCUR PERSONAL & ADV INJURY $1,000,000
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $1,000,000
-
- FIRE DAMAGE (Anyone fire) $100,000
MED EXP (Anyone person) $5,000
AUTOMOBILE LIABILITY $500,000
- COMBINED SINGLE LIMIT
A ~ ANY AUTO CPP0710364 11/01/00 11/01/01
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
HIRED AUTOS BODILY INJURY
- $
NON-OWNED AUTOS (Per accident)
f--
I--- PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
I--- :::::::::::::::::::::::::::
ANY AUTO OTHER THAN AUTO ONLY:
f--
EACH ACCIDENT $
I---
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $5,000,000
A M UMBRELLA FORM CCC4407054 11/01/00 11/01/02 AGGREGATE $5,000,000
OTHER THAN UMBRELLA FORM $
WORKERS COMPENSATION AND IWCSTATU- I 10TH-
TORY LIMITS ER
EMPLOYERS' LIABILITY -ELEACP.-ACCIDBII-=-_ ~ -S-OO-c, QOO-
---- --_.--_.----~-,-"--'---~ - ----- Fr~~~ -- -----'._--~-- -.-- -- -------,-~,~---~ 1-------- ---'.'":"------=-- ---
C THE PROPRIETOR! 21WBEU3012 01/01/01 01/01/02 EL DISEASE - POLICY LIMIT $ 500,000
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE $ 500,000
OTHER
B Crime Section 21DDDLA4133 11/01/00 11/01/01 Fideli ty 500000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
Re: 121 N. Osceola Avenue, Clearwater, FL. Certificate Holder is included
as Additional Insured.
: qERTJFlqAT:E: HPLDE:R:::::.... . . . . . . . . ........<....::.:<...:<:..::::<:::::<::::::::<:CANCELLATION::'"
................................... .
CITY080 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Clearwater EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
...-\
Attn: Earl Barrett I ~ @J ~ 0 ~ DA rsv tTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Public Works AdministratiOn\~ I ~( \ AIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
P . 0 . Box 4748 I .
Clearwater FL 33758-4748 lini OF ANY KI b I~F N THE COMPANY. JJ:.S AGENTS OR REPRESENTATIVES. -
liiU DEe 2 ~U2mJfED ~EAA ENTATlVE =m tI. I'A ,A~'I
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