CERTIFICATE OF INSURANCE
~-~-~-~-~-~-~-~-~-~-~----~-~----~-~-~-~-~-~_I~-~------------------------------------------J..._~~~~~_~~~~_~~~~~~~~~~~~~__~~~~~:~~~
iPRODUCER I THIS CERTIFICATE IS ISSUED AS A MATTER 0;:- II\;;OR~ii:r;ifJN ONLY AND CONFERS NO
!BurKe-Lehman Insurance I RIGHTS UPON THE CERTIFICATE HOLDER. ThIS CE;TI~ICATE DOES NOT AMEND,
12173 NE Coacnman Rd. I EXTEND OR ALTER THE COVERAGE AFFORvED BY THE ~'QLICiES BELOW. I
IClearwater Florida 34625 1-----------------------------------------------------------------~--~----------~~--i
I~~~~------~-----------~~~=~~~~--------------l-----------~-~-~-~-~-~-~-~-~-~----~-:-~-~-~-~-~-~-~--~~~-t;~~~~~-~-~~---:
iINSURED I COMPANY LETTER A: THE OHIO CASUALTY GROUP
IHarbor View Beauty Stvies 1 COMPANY LETTER B:
IBetty PerrIno DBA I COMPANY LETTER C:
125 CauSeway Blvd. I COMPANY LETTER D: FEB 00 1~
I Clearwater' FL 34530 I COMPANY LETTER E: ~ ~
Iii
i= COVERRGES ====================================================================================================================1
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE ~'OLICY 1
PERIOD .INDICATED! NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OThER DOCUpiENT WITHJi~T/ 1
1 TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRf)BtHE - .,~' i
j SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEE~Rt~D BY PAID CLAIMS. i
i--------------------------------------------------------------------------------------------------------------------------------1
leD i TYPE OF INSURANCE I POLICY NUMBER ; POLICY ,POLICY EJPIR-j ALL LIMiTS I1~ l'HOiJ3H,~DS
iURi 1 I EFFECT. DATE I ATION DATE j
I I I i MM/DD/YYYY I MM/DD/YYYY I
1---1----------------------------------1---------------------------i------------I-------------j----------------------------------i
i A i GENERAL LIABILITY I BZW50151532 i 3/20/19'10 3/20/1991 I GENERAL AGGREGATE .1; 2,000
i mCOMMERCIAL GENERAL LIABILITY , 1 PRODiJCTS-COMPiO~'S
I i AGGREGAE
[ }claims made [X]occurrence i IPERS. & ADVERTISING
I 1 1 INJURY
I[ JOWNERS & CONTRACTORS PROTECTIVE I I
i I I EACH OCCURRENCE $ ~! !)(l0
,[ ] 1 1 FIRE DAMAGE (ANY ONE
i i i FIRE)
j[ ] I iMEDICAL EXPENSE (ANY
1 i I I lONE PERSON) : $ 5 ;
I---j----------------------------------i--~------------------------1------------1-------------1----------------------1-----------:
1 IAUTOMOBILE LIABILITY 1 i j iCOplBINED SINGLE LiMIT 1 -~
I IE] ANY AUTO i ibODiLY INJURY
I [ ] ALL OWNED AUTOS I' (PER PERSON)
I[ ] SCHEDULED AUTOS i iBODILY INJURY
I[ ] HIRED AUTOS i I (PER ACCIDENTi
1 [ ] NON-OWNED AUTOS 1 I
I [ ] GARAGE LIABILITY I iPROPERTY DAMAGE I $
,[ j j Ii! I
1----1----------------------------------1---------------------------1------------1-------------1----------------------------------i
'EXCESS LiRBILITY I EACH OCCURRENCE AGGiiEGATE
j [ j J I
1 "nil"'"] -OTBER"UrHAN ~ttRtLLi~rF{)RM I --1 I ----- --------,----- n_n.,_ --..'$.------.---- -
1---1----------------------------------1---------------------------j------------I-------------I----------------------------------i
i I WORKERS' COMPENSATION ill I STATUTORY
I AND I i I $ i:ACH ACCIDENT! !
I EMPLOYERS' LIABILITY i j $ (DISEASE-POLICY LIMIT) I
! Iii I j $ \DISERSE-EACH EP1PLOY. i i
I---j----------------------------------;---------------------------1------------1-------------1----------------------------------1
i j OTHER i I I i
I ! I i
i I j
i j Iii i
1--------------------------------------------------------------------------------------------------------------------------------1
IDESCRIPTIONS OF OPERATIONS/LOCATIONS/VEHICLES/RE5TRICTIONS/SPECIAL ITEMS i
1 .. j
~Ii_ rt-R~IFICH~7' Wu-; DEO ---------------------------- CANCELLATION -----------------------------------------------------------------,:
-;..r I ~ C. ! I L. 1\ ---------------------------- n --------------------------------------------------------,---------
1 SHOuLD ANY OF THE ABOVE DESCRIBED ~OLICItS BE CANCELLED BEFORE THE I
i EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAiL I
i 3(; DAYS WRITTEN NOTIC( TO THE CEiFIFICATE HOLUER NAMED TO THE LC:FT, i
i BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LiABIL- I
I ITY OF ANY KIN] UPON ThE COMPANY, ITS AGENTS OR REPrlESENTATIVES.
j I-------------------------------------~------------------------------------------i
l_______________________________________________~_:~:~;~~__~_~~~_~~~:___________________._______i
ACORD 25-S (3/,3.3, ACGRI: is a registe.'2u tr;i(jEmal'k c,f ACORD C':(~pot'a~i,~c.
$ 1,000
$
$
:10
$
$
; City of Clearwater
P.O: Box 4748
Cieat'watel', Fl.
34618-4748
///-),7
: ~.,Hk~.lij;. :
THIS CERTIFICATE IS IS$U~O Mi ^ MA HER Of INFOHMATION ONL Y AND CONFEHS
NO RIGHTS UPON THE CERTIFICA TE HOLDER, THIS CERTIFICA TE DOES NOT AMEND,
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
.'. i..', ,'EH:UO INOII~;'! EL'
':... ':"J'n~r, ThiS CERTIFIC/.. Tt: Mi~ 'r
:1'" IeI'M::;, C:XCLUSIONS, AND CaNOl.
b I., ,.-. j':.e--Leh rnan L .ns I.l'r'a nCl::!
2 J. /.:i I\iL C'::lachrnan r<C1.
Llearwater, FlorlCa 34b~
COMPANIES AFFORDING COVERAGE
COMPANY
LETTER
A THE OHIO CA_SUAl."JY."" y~9~'-.
zj, 1.. \..,,' ....... "" oJ
INSURED
I f2MPANY B
~TTER
. COMPANY C
: LETTER
1
j;.ev~ 8~0~~,..:~y S.tv,.~,_..
L... c.~, :,1 i; l~~ V-.; ~\ "/ E~:t \/ r:i "
".
....at
I
I;:'L 3't630
COMPANY D
LETTER
COMPANY E
I LETTER
'QV
i"i-i/S is i U :..',':n":':F'1 ;'r'lH i )-"'"/~.;'';iL..J vt- ;r~~,...;i,A;,',,;t. ..~~: t:~i ,i~~ '.J (. ~'ct.... ISSueD TG r,.lt :',
l"-iOT\N,THSTANUIN~ ,'1';'1 ;'"\{>J;..jlnci'~lL~1 '"::riM l:'i''-i .;(....'t~(~'..:.i0t"1 0t' -..',y ,..LJi'~TRACT OR OTrlct".::'
I:lE ISSUED OR M~.( P"R;t,lh. rHE: ii'iSVH;:.",CE A::r:UROED By ThE :.'0~1(';i::, DESCRIBED MErit:..,
nONS OF SUCH POLICIES
TYPE OF INSURANI.:;E
?OLley E~Fi:Ci':'..t
OA TE IMMiDDiY'{;
0.:; / (? 0 / E\'".:j - I (: :~ / ~:=::) / 9 (I
I
\ $ 1$
, I
i i)HOPEH TV I
DAMAGE I $ I $
POL-ICY NUMBER
GENERAL LIABILITY
X COMPREHENSIVE FOAM
X PREMISES/OPERA nONS
UNOERGROUNO
EXPLOSION & COLLAPSE HAZARD
X PRODUCTS/COMPLETEO OPERA nONS
. CONTRACTUAl
INOEPENDENT CONTRACTORS
BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY
XBW 50151622
~~t~~ED $ 1000 $
~ERSONAL INJURY $
tf) G' If.
0' (',)/"../v ,.
~'-
"~"..:~ . ,. .-, ....~~
~~ ~~-~~. ' .' . ~
,.,0uLW ANY U" I He. I-Idu, L c1~"'-hldf.l.J foUL,";I.." de. (~ANCf;....cLl I:It::FORt I ni: EX.
~1:1~T10~CP~~~s ~R~:;E~~o~7;E ~~S~~~GCE~~I~I~~~~ H~~~LERE~~~:6~~ T~~
..Er-r,I:IUT FAILURE TO MAIL ':iUCH NOTICE SHAL.L IMPOSE NO OBLIGATION OR LIABILI1Y
OF ANY KIND UPON THE COMPANy ITS AGENTS OR REPRESENTATIVES.
. .-~---------:' -.~----""._. .:...-..------.-----..----- --- ......-..- '---'1
i.. I., nl()R~ ~EPRESENU! i J:_<.,
f I 'if '.E, ( ,e.
'6 .. Y7>-.-i _f., .. lA" j'-
.., ':~i.ii.t~tf:~~!i!f.~~~lir~~~;: 1,.). .,.r'ft.,..,.7f'..~
~.:i::~:-.:~J1!~~!'a'iIa~~:1;..~.:~~~;.'..., .-.-~.'" :
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS (PRIV. PPSS.)
ALL OWNED AUTOS (OTHeR THAN)
PRIV. PASS.
HIRED AUTOS
NON.OWNED AUTOS
GARAGE LIABILITY
. - ------r8C,C;,-:--T----
! l~jUIi'
iPfR P:il:,QNI $
0001'./
INJuRl
IPER ACCIDENT) $
PROPERTY
DAMAGE $
--r-- I'__
I EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMtlHELLA FORM
I BI 6 ~C I
: COMBINEO i $
- ,.-----i 16;;~'O 1$
1----'
STATUTOAY
WORKERS' COMPENSATION
AND
EMPLOYERS' LIASILITY
~-
i fL..-
, $
OTHER
t'
DESCRIPTION OF OPERA TIONS/LOCA TIONSNEHICLES/SPECIAL ITEMS
/. c:- <' I (:'". I
6- It f) [) E F L 0 C K L.< L n ~ ~ -. ~
'-' J_Q....<..(-"~,.~
. >,
c+ C l-e.c-vLMC'_+ e.....
8,::, x. I.,. 7413
11 I, e Q Y"Wd ;; t':.,. 'J ,.. (..
-a~L,,(g-1..(.74g
:~{~f:':.;'{<:~!f'
~1:;~]~('
:J.' .' "
.--.~., "
$
I
C"
!EACH ACCIDENT)
:OISEASE.POllCY lIMln
(DISEASE.EACH EMPLOYEEi