CERTIFICATE OF LIABILITY INSURANCE (4)
A caRD CERTIFICATE OF LIABILITY INSURANC~~~2 DATE (MMIDDIYY)
.A ___.._n_. .-. - -".----------- "" 04/05/01
PRODUCER THIS CERTIFICATE IS ISSUED AS A MAHER OF INFORMATION
The Connelly Insurance Group ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
630 Chestnut Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 2456 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
Clearwater FL 33757-2456 COMPANIES AFFORDING COVERAGE
--"----,------~-'"--'-----~---"----"--"""----
William Hancock COMPANY
A Scottsdale Insurance Co.
.f>_Il,!!,a No, 727-461-6044 Fax No" 727-442=-1~_95 'u -------
INSURED COMPANY
B Fireman's Fund Insurance Co.
~ "- - ~ .---
Palm Pavilion of Clearwater, ! COMPANY
The Four Suns, Inc. I C
10 Bay Esplanade I COMPANY
Clearwater FL 33767 ! D
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOlWlTHSTANDING 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" LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS"
I I
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION I LIMITS
LTR DATE (MM/DDIYY) DATE (MM/DDIYY)
GENERAL LIABILITY I i GENERAL AGGREGATE $2,000,000
-
A ~ COMMERCIAL GENERAL LIABILITY BCSOOO1307 04/05/01 04/05/02 ! PRODUCTS-COMP/OPAGG ~lJil~~ 00 <2___
=:J CLAIMS MADE ~ OCCUR I
i PERSONAL & ADV INJURY $ 1,000,000
f--- I EACH OCCURRENCE "--"---
OWNER'S & CONTRACTOR'S PROT $1,000,0_~
r---
f--- FIRE DAMAGE (Any ona fi,a) $ 100,000
MED EXP (Any ona person) $ EXCLUDED
AUTOMOBILE LIABILITY
f--- COMBINED SINGLE LIMIT $
ANY AUTO
r---
ALL OWNED AUTOS i BODILY INJURY
f--- $
SCHEDULED AUTOS (Par person)
r--- I
f--- HIRED AUTOS BODILY INJURY $
NON-oWNED AUTOS (Par accident)
r---
- . PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
- --
ANY AUTO OTHER THAN AUTO ONLY:
- ' -"----""---~
- EACH ACCIDENT ' $
-~
AGGREGA TE $
EXCESS LIABILITY EACH OCCURRENCE $2,000,000
B ~ UMBRELLA FORM XYZ84555192 04/05/01 04/05/02 AGGREGATE $2,000,000
--
OTHER THAN UMBRELLA FORM $
WORKERS COMPENSATION AND ~STATU- ! _~
I EMPLOYERS' LIABILITY TORY L1~ITS i _ ER ~"----------
EL EACH ACCIDENT is
THE PROPRIETOR! , --
RINCL EL DISEASE - POLICY LIMIT i$
PARTNERS/EXECUTIVE --
OFFICERS ARE: , EXCL EL DISEASE - EA I!MPLOYEE i $
OTHER
I
I I
!
DESCRIPTION OF OPERA TlONSlLOCA TlONSNEHICLESlSPECIAL ITEMS
RE, ~uiidin~ #2 - 332,S. Gulfview Blvd. Cle~rwater Bea9h, FL. and
~U~ld~ng 3-3 0 S.Gulfv~ew Blvd., Clearwater; 50,000. Bu~ldin~ coverage &
10tOOO. Contents. All prop'erty coverage based on Replacemen Cost basis.
er ificate Holder is incluaed as Addit~onal Insured.
CERTlFICA TE HOLDER CANCELLA TION
CITYO-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Clearwater EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
FAX # 462-6957 ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Attn: Catherine Yellin
25 Causeway Blvd. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
Clearwater FL 33767 OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES"
AUTHORIZED REPRESENTATIVE ,
William Hancock ~/A oAft.J
ACORD 25-5 (1/95) ~ .. O~D Y"'U
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