CERTIFICATE OF LIABILITY INSURANCE (7)
ACORDTM
CERTIFICATE OF liABiliTY INSURANCE
BCJI . DATE
P4DD 09-02-2004
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.
PRODUCER
BROWN & BROWN PINELLAS/PHS
224605 P: (866)467-8730 F: (877)538-8526
P. O. BOX 29611
CHARLOTTE NC 28229
INSURED
INSURERS AFFORDING COVERAGE
INSURERA:Hartford Ins Co of the Southeast
INSURERB:Hartford Underwriters Ins CO
INSURER C:
INSURER 0:
INSURER E:
GREENWOOD COMMUNITY HEALTH
1108 NORTH MARTIN LUTHER KING AVENUE
CLEARWATER FL 33755
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 ~~~rM~~~~~ P81~llflM"Jo~~r LIMITS
LTR
~ERAL L1ABIUTY EACH OCCURRENCE $1,000,000
A COMMERCIAL GENERAL LIABILITY 21 SBA BM2386 05/02/04 05/02/05 FIRE DAMAGE (Anyone fire) $300,000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $10,000
X :Business-Liab -,- - - - $1,000,000
PERSONAL & ADV INJURY
GENERAL AGGREGATE $2, 000, 000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2, 000, 000
"I POLICY II ~~8T I xl LOC
~TOMOBlLE LIABILITY COMBINED SINGLE LIMIT $1,000,000
A ANY AUTO 21 SBA BM2386 05/02/04 05/02/05 (Ea accident)
f--
f--- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
.--
~ HIRED AUTOS BODILY INJURY
$
~ NON-OWNED AUTOS (Per lICCident)
PROPERTY DAMAGE $
(Per lICCidentl
~AGE L1ABIUTY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
t:1' OCCUR U CLAIMS MADE AGGREGATE $
~ DEDUCTIBLE $
$
RETENTION $ $
WORKERS COMPENSATION AND X I ~~.;n~~~ I 101~-
B EMPLOYERS' LIABILITY 21 WEC GC3515 10/03/04 10/03/05 dOO,OOO
E.L. EACH ACCIDENT
EL DISEASE - EA EMPLOYEE $100,000
EL DISEASE - POLICY LIMIT $500,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Those usual to the Insured's Operations.
CERTIFICATE HOLDER
I ADDITIONAL INSURED; INSURER LETTER:
CANCELLATION
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-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,
City of Clearwater Florida
Attn: Diane Huford
112 South Osceola Avenue
Clearwater, FL 33756
AUTHORIZED REPRESEN~E
~~~~~
ACORD 25-S (7/97)
e ACORD CORPORATION 1988