CERTIFICATE OF INSURANCE (7)
~AddRDN
PRODUCER
Brown & Brown Insurance
630 Chestnut Street
P.O. Box 2456
Clearwater FL 33757-2456
Phone: 727-461-6044 Fax:727-442-7695
CERTIFICATE OF LIABILITY INSURANCl;oLfr~~ B DA~E~;~~D70)3
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.
INSURERS AFFORDING COVERAGE
INSURED
INSURER A:
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
.M~tional Trust Insurance~_
Nat'l Union Fire Ins Co of PA
Hartford Ins. Co. of the S.E.
Lee Arnold & Associates dba
Colliers Arnold etal
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.
II~~G TYPE OF INSURANCE POLICY NUMBER ~~~lfTM~~~~rt: I t"~..tf'E~='r~)N LIMITS
GENERAl LIABILITY
~
A X COMMERCIAL GENERAL LIABILITY
~ =:J CLAIMS MADE [!J OCCUR
11/01/03
11/01/04
EACH OCCURRENCE
FIRE DAMAGE (Anyone fire)
MED EXP (Anyone person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
CPP0002082
GEN'L AGGREGATE LIMIT APPLIES PER:
II POLICY n ~~8T n LOC
AUTOMOBILE LIABILITY
I--
A ~ ANY AUTO
ALL OWNED AUTOS
I--
~ SCHEDULED AUTOS
~ HIRED AUTOS
X NON-OWNED AUTOS
I--
11/01/03
11/01/04
COMBINED SINGLE LIMIT
(Ea accident)
CA0002599
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
f--
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY
R ANYAUTO
EXCESS LIABILITY
B t:!J OCCUR D CLAIMS MADE
~ DEDUCTIBLE
XI RETENTION $10000
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
AUTO ONLY - EA ACCIDENT
EA ACC
OTHER THAN
AUTO ONLY:
11/01/03
11/01/04
EACH OCCURRENCE
AGGREGATE
EBU3140815
21WBEU3012
01/01/03
X I TOR~'UMYTSI IU~~-
01/01/04 ELEACHACCIDENT
C
.H~~'
-- ..E.L. OISliNH. Ei'~"
E.L. DISEASE - POLICY LIMIT
OTHER
$1000000
$ 100000
$ 5000
$1000000
$2000000
$ 2000000
$ 1000000
.
$
$
$
AGG
$
$
$
$ 10000000
$ 10000000
$
$
$
$ 500000
500000
$ 500000
I r-: ffi fii2 ~ f! '- ,;,,---- r \~l
DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS I u. I .. .... '! 'I
Ref: 121 N. Osceola Avenue, Clearwater. The certificate holder is an t' . -'. .1 i
additional insured under the terms & conditions of the liability polic ~ t NOV ~ 0 ';1 !'1 II II
only with respect to the premises located at 121 N. Osceola Avenue. i' ,--'
I
I
CITY 01 C: ;
f'llp! Ie WORK~, i
CERTIFICATE HOLDER
I y I ADDITIONAL INSURED; INSURER LETTER: A
CANCELLATION
'i
CITY080 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ..3.L DAYS WRITTEN
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!:!!!:!.O~ED REPRESENTATIVE a (~ ~A 'A~4'~
Ylla' ,~'III ~ "' . - --;
, @ACOR~ORPORATION 1988
City of Clearwater
Attn: Earl Barrett
Public Works Administration
P.O. Box 4748
Clearwater FL 33758-4748
I
ACORD 25-5 (7/97