CERTIFICATE OF INSURANCE (6)
.
Pfto:JDUCER '
The Connelly Insurance Group
630 Chestnut Street
P.O. Box 2456
Clearwater FL 33757-2456
Phone:727-461-6044 Fax:727-442-7695
CERTIFICATE OF LIABILITY INSURANC~gr~~ A DA~E;~~~;;'~
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
ACORDm
INSURERS AFFORDING COVERAGE
INSURED
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
Travelers Indemnit Company
Lee Arnold, Jr & Herbert Brown
dba Arnold Brown Properties
17757 US Hwy 19 N Ste 275
Clearwater FL 33764
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
LTR
TYPE OF INSURANCE
b~~~rM'fXbij?-l{.YE Prf..H~~~r&~J}?N
POLICY NUMBER
GENERAL LIABILITY
'---,
A X COMMERCIAL GENERAL LIABILITY
I CLAIMS MADE [!] OCCUR
EACH OCCURRENCE
FIRE DAMAGE (Anyone fire)
M ED EXP (Anyone person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COM PlOP AGG
I6606792N2074COF
11/01/02
11/01/03
-
GEN'L AGGREGATE LIMIT APPLIES PER:
I POLICY n jr8T n LOC
AUTOMOBILE LIABILITY
-
A ANY AUTO
-
11/01/02
11/01/03
COMBINED SINGLE LIMIT
(Ea accident)
I6606792N2074COF
ALL OWNED AUTOS
BODILY INJURY
(Per person)
-
SCHEDULED AUTOS
-
X HIRED AUTOS
-
~ NON-OWNED AUTOS
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY
=1 ANY AUTO
EXCESS LIABILITY
~ OCCUR D CLAIMS MADE
I DEDUCTIBLE
I RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
AUTO ONLY - EA ACCIDENT
OTHER THAN
AUTO ONLY:
$
EA ACC $
$
$
$
$
$
$
EACH OCCURRENCE
AGGREGATE
--
-
I TORY LIMITS I IUER-
-E~&A~U-AGGIDEN..-_._- - --$-
EL. DISEASE - EA EMPLOYEE $
EL. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Buildings or Premises - Office, LRO located at 121 Osceola Avenue,
Clearwater, FL 33775
The certificate holder is an additional insured with regard to the parking
area located at 421 Drew Street Clearwater, FL 33755
CERTIFICATE HOLDER
I y I ADDITIONAL INSURED; INSURER LETTER: A
CANCELLATION
LIMITS
$1,000,000
$ 100,000
$ 5,000
$1,000,000
$2,000,000
$2,000,000
$1,000,000
$
$
$
AGG
CITY074
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
City of Clearwater
Attn: Earl Bar ~... R...liil., R
:U~l~~x w~~~: Ad ~ i,~r~i~ D W ~ ill
Clearwater FL 3 In! -4748 U
I Ul 0 - 4 .
ACORD 25-S (7/97)
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
REPRESENTATIVES.
A!lI.!:!O~ED REPRESENTATIVE a
YJ7a- .#tA .. , .
,
L~~ .-~f1
-- - A
@ACORJJfoeORPORATION 1988
CITY OF CLEARWATER
PllBlIC ~ ADMINISTRATION