CERTIFICATE OF LIABILITY INSURANCE (3)
DATE: 04/11/02 TIME: 04:33 PM TO: Diane Huford @ +1 (727) 5624075
PAGE: 001-002
ACORD.. CERTIFICATE OF LIABILITY INSURANC~3~15 I DATE (MMIDD/YY)
04/11/02
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
The Connelly Insurance Group ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
21-224605-AP-NC-XSA-GL HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 29611 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Charlotte NC 28229
Phone: 800-448-5462 Fax: 704-921-4651 INSURERS AFFORDING COVERAGE
INSURED INSURER A: Hartford Ins. of the Southeast
INSURER B:
Greenwood Community Health INSURER C:
1108 N Greenwood Ave INSURER D:
Clearwater FL 33755
I INSURER E:
COVERAGES
._----_."'-"---_.._-,--_.,---,._-----,-_.__._._.,~._-,.--...---.'-..'.------.--.---.----..---..--------.--.."-.-
THE POUCIES OF INSURANCE LISTED BELO\/V HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR COODITlON OF /!NY CON 'TRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERllFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE PQ.IOES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLlOES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
=----- .-----~.---~;------- ---.-'.---.----,----------, _________m_______.____._
I~iif TYPE OF INSURANCE POLICY NUMBER' bi\bC~Iij,~B~:f{')'E PD'}~Y E~k\~~WN LIMITS
--'------------------- --~-_ ..___._(PII_________________..._____. -. ---...-...._--.-,,,._--
GENERAL LIABILITY EACH OCCURRENCE $
-
3MMERClAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $
- CLAIMS MADE D OCCUR
MED EXP (Anyone person) $
-
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
f---
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
h nPRO- n
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
f--- $
ANY AUTO (Ea accident)
f---
ALL OWNED AUTOS BOOIL Y INJURY
I-- (Per person) $
SCHEDULED AUTOS
-
HIRED AUTOS BOOIL Y INJURY
- $
NON-OWNED AUTOS (Per acciden~
-
PROPERTY DAMAGE $
(Per acciden~
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
Q OCCUR D CLAIMS MADE AGGREGATE $
$
q DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND TWC STAlu- ; I 10TH-:
X TORY LIMITS ER
A EMPLOYERS' LIABILITY 21WECGC3515 10/03/01 10/03/02 $ 100.,000
EL EACH ACCIDENT
FL DISEASE - EA EMPLOYE! $100,000
E L DISEASE - POLICY LIMIT $ 500 ,000
OTHER
DESCRIPTION OF OPERATIONSlLOCATICWSNEHICLESlEXCLUSlCWS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Those usual to insureds operations.
CERTIFICATE HOLDER I N 1 ADDITlCWAL INSURED; INSURER LETTER: CANCELLATION
CITYCll SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
-
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO so SHALL
City of Clearwater Florida IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Attn: Diane Huford
112 S. Osceola Ave I REPRESENTATIVES.
Clearwater FL 33756 i -pfa-rf<-( I( fJVflt-
, I
ACORD 25-S (7/97)
@ACORDCORPORATION 1988
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