CERTIFICATE OF LIABILITY INSURANCE (5)
ACORD,,* CERTIFICA TE OF liABiliTY INSURANCE DG ~I DATE
U022 08 20-2003
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
BROWN & BROWN PINELLAS/PHS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
224605 P: (866)467-8730 F: (877)538-8526 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. O. BOX 29611
CHARLOTTE NC 28229 INSURERS AFFORDING COVERAGE
INSURED INSURER A: Hart ford Ins Co of the Southeast
INSURER B: Hart ford Underwriters Ins Co
GREENWOOD COMMUNITY HEALTH INSURER c:
1108 N GREENWOOD AVE INSURER 0:
CLEARWATER FL 33755 INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REOUIREMENT, 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 TYPE OF INSURANCE POLICY NUMBER r:lWrJ~~~~~~ "gk!fEY'~'t.I,~~J.J~~ UMITS
LTR
re~- EACH OCCURRENCE I $1, 000, 000
A COMMERCIAL GENERAL LIABILITY 21 SBA BM2386 05/02/03 05/02/04!FIREDAMAGE(Anyonefirel 1 $300, 000
CLAIMS MADE L!J OCCUR 1 MED EXP (Any one person) I $10, 000
cf Business Liab PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
n'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
POLICY i -I jr8i- iX-I LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
A ANY AUTO 21 SBA BM2386 05/02/03 05/02/04 (Ea accidentl
-
- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per personl
-
~ HIRED AUTOS BODilY INJURY
$
X NON-OWNED AUTOS (Per accident)
-
~ PROPERTY DAMAGE $
(Per accident I
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
~ESS LIABILITY _ I EACH OCCURRENCE $
o OCCUR U CLAIMS MADE AGGREGATE $
I-- $
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X 1~~JT~~sl 10J~-
B EMPLOYERS' LIABILITY 21 WEC GC3515 10/03/03 10/03/04 $100,000
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE $100,000
-- -. _. $500,000
E.L. DISEASE - POLICY LIMIT
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSiVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Those usual to the Insured's Operations.
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
City of Clearwater Florida
Attn: Diane Huford
112 S. Osceola Ave
Clearwater, FL 33756
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE (10 DAYS FOR NON-PAYMENTI 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.
ACORD 25-S (7/97)
AUTHORIZED RE. PRESENT~E
~S~.:~~~dl.cL...
rQ ACORD CORPORATION 1988