CERTIFICATE OF LIABILITY INSURANCE (6)
ACORDTM CERTIFICATE OF liABiliTY INSURANCE
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BCJI DATE
P4DD 03-09-2004
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 NORTH GREENWOOD AVENUE INSURER D:
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 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 TYPE OF INSURANCE POLICY NUMBER r:i~rM~~~g~~ "8k!.fl(~JlC~J.J~~ LIMITS
LTR
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
A f-- 21 SBA BM2386 05/02/04 05/02/05 $300,000
>-- ~MMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire)
1 CLAIMS MADE lKJ OCCUR MED EXP (Anyone person) $10,000
~ Business Liab 1- PERSONAL & ADV INJURY $1,000,000
~ GENERAL AGGREGATE $2, 000,000
GEN'L AGGREGATE LIMiT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
-I POLICY II j~8i- I X -I LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
-
A ANY AUTO 21 SBA BM2386 05/02/04 05/02/05 (Ea accident)
-
ALL OWNED AUTOS I I
- BODILY INJURY $
SCHEDULED AUTOS (Per person)
-
~ HIRED AUTOS BODILY INJURY
$
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
=1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
~~ ~.,~ EACH OCCURRENCE $
OCCUR U CLAIMS MADE AGGREGATE $
1 $
--l DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X 1 WC STA~~~ 1 10l~-
TORY IMI
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
E.L. DISEASE - POLICY LIMIT $500,000
, OTHER'
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Those usual to the Insured's Operations.
'.
CERTIFICATE HOLDER 1 I ADDITIONAL INSURED; INSURER LETTER:
ICity of Clearwater Florida
Attn: Diane Huford
112 South Osceola Avenue
Clearwater, FL 33756
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE I
EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE (10 DAYS FOR NON-PAYMENT) 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.
AUTHORIZED REPRESENT~E
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ACORD 25-S (7/97)
e ACORD CORPORATION 1988