CERTIFICATE OF INSURANCE
'"
A CORD_
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THIS CERTIFICATE IS ISSUED AS A MA TIER 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.
COMPANIES AFFORDING COVERAGE
PRODUCER
Mutual Insurance Agency
at Clearwater, Inc.
P.O. Box 1779
Clearwater FL 33757-1779
John Gay
Phone No. 727-446-6064 Fax No. 727-442-9751
INSURED
COMPANY
A
Auto Owners
COMPANY
B
Bruce Littler, Inc.
25 Causeway Blvd.
Clearwater FL 33767-2064
CQYEAAGI;$......:...:..:.::..:::::.:::::::.:.:.:::.:.:.:::::.:.:.:::::::::.:::.:::.:::
COMPANY
C
COMPANY
D
.. "0... ...
.. .........
.. .... -....
........ .
. . . . . . . . . . . . . . . . . .
,... -.....
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN :SSUED 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 POLlCIES_ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/ODIYY) DATE (MM/ODIYY)
A
~NERAl LIABILITY
X COMMERCIAL GENERAl LIABILITY
_._:_' I CLAIMS MADE [!] OCCUR
OWNER'S & CONTRACTOR'S PROT
91-130168-00
04/01/02
04/01/03
LIMITS
'.
GCNERAl AGGREGATE $ 300000
PRODUCTS - COM PlOP AGG $
-
PERSONAL & ADV INJURY
EACH OCCURRENCE
FiRE DAMAGE (Anyone fire)
"'ED .EXP (Anyone person)
$ 300000
$ 300000
$50000
$ 5000
-
AUTOMOBILE LIABILITY
~
~ ANY AUTO
ALL OWNED AUTOS
~
~ SCHEDULED AUTOS
I--- HIRED AUTOS
COMBINED SINGLE LIMIT .' $
BODILY INJURY
(Pet person)
$
~
I---
NON-OWNED AUTOS
BOOIL Y INJURY
(Per accidenl)
$
PROPERTY DAMAGE
$
~GE LIABILITY
~ ANY AUTO
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
$
I>:.:.:::::: :. >: ·
.
EACH ACCIDENT $
AGGREGATE $
$
S
s
]OJ~'
$
EL DISEASE - POLICY LIMIT $
ELDISEASE . EA EMPLOYEE $
EACH OCCURRENCE
.'
EXCESS LIABILITY
RUMBRELLAFORM
. OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPlOYERS' LIABILITY
AGGREGATE
,
.'
.IWCSTATU- I
'TORY LIMITS
EL EACH ACCIDENT
>>>
THE PROPRIETOR!
PARTNERSlEXECUTIVE
OFFICERS ARE:
OTHER
R.INCL
EXCL
A Plate glass
04/01/01
04/01/~
ACV
DESCRIPTION OF OPERA TIONSlLOCA TIONSNEHICLESlSPECIAL ITEMS
Gift shop -aJ2t
City of Clearwater is named as an Additional Insured.
CI:~rl~c;ATIS.H9t;D~::.::::::::::::::::::::::::::::::::::::::::>::.:::::::::>::::::::: ::::::::::::::::::::::::::::~(:E:~t;ATIDN:::::::"':::"':::::::::: -_-c_-_:-.--:_-:::::::::_:. .::::: . : :.:_::_...::::.:._-<.:-:....
CITYO 0 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAlL
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAlL SUCH NOTICE SHAlL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPOI)I.JHE COMPANY,ITSAGENTS OR REPRESENTATIVES_
AUTHORIZED REPRlfE~TA~
John Gay ~. "-
AC~Q:~~$ :(1 i'$~)::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::.:::::::::::::::::::::::::::::::::::::::::.:::::::::::::.:::: :::::::::::::.:.::::::::::. ~ ,_
IJ
City of Clearwater
Bill Morris - Barbormaster
25 Causeway Blvd
ClearwaterFL 33767-2604
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