CERTIFICATE OF INSURANCE (3)
ACORD..
::CE:t{Tl:FtCAtE:::Q:F:::LlAEULftY:::ir-~J$j::JO::i\:N:C'.:::-:B!~:ji{d.~::::<<< DATE (MMlDDIYY)
. . : >.: -: -:.:. >.::::::'::.':::':'::: >.:::. - -:.:::::.: >::::.:. :.::: -:. -':: >:::::::.:.::.::::::.:. >:.: -:.:.: -: -:::.:::::.: >::::.:.:: >:':'.:: :~: ~::::.::: - _':' >:.:. :J;;;I;~~~~:;L::::::::::::: 02/19/03
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.
COMPANIES AFFORDING COVERAGE
PRODUCER
Mutual Insurance Agency
at Clearwater, Inc.
P.O. Box 1779
Clearwater FL 33757-1779
John Gay
Phone No. 72 7 - 44 6 - 6 064 Fax No. 7 2 7 - 442 - 97 51
INSURED
COMPANY
A
Auto Owners
COMPANY
B
Bruce Littler, Inc.
25 Causeway Blvd.
Clearwater FL 33767-2064
COMPANY
C
COMPANY
D
:COVeAAGeS::::::::::::::::::::::::::::::::::::::::::::::::::::
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THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DDIYY) DATE (MM/DDIYY)
LIMITS
GENERAL LIABILITY
-
A X COMMERCIAL GENERAl LIABILITY 91- 13 0168 - 0 0
::::::: I CLAIMS MADE W OCCUR
OWNER'S & CONTRACTOR'S PROT
04/01/03
GENERAL AGGREGATE $ 300000
04/0 1/04 PRODUCTS - COMP/OP AGG $
PERSONAL & ADV INJURY $ 3 000 00
EACH OCCURRENCE $ 3 0 0 0 0 0
FIRE DAMAGE (Anyone fire) $ 50000
MED EXP (Anyone person) $ 5000
-
-
AUTOMOBILE LIABILITY
I--
ANY AUTO
COMBINED SINGLE LIMIT
$
f--
r---
r---
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
BODILY INJURY
(Per person)
$
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-
-
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
$
GARAGE LIABILITY
-
ANY AUTO
AUTO ONLY" EA ACCIDENT
OTHER THAN AUTO ONLY:
$
-
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THE PROPRIETOR!
PARTNERS/EXECUTIVE
OFFICERS ARE:
OTHER
R'NCL
EXCL
EACH ACCIDENT $
AGGREGATE $
EACH OCCURRENCE $
AGGREGATE $
$
/WCSTATU- I IOETRH- ':-:-:-:-:.
TORY LIMITS I :.:.:.:.:-'
EL EACH ACCIDENT $
EL DISEASE" POLICY LIMIT $
EL DISEASE - EA EMPLOYEE $
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EXCESS LIABILITY
RUMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
A Plate glass
04/01/02
04/01/03
ACV
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESlSPECIAL ITEMS
Gift shop
City of Clearwater is named as an Additional Insured.
: CE!R:rIf:lc;ATe;:H9L:DE~:::::::::
. . . .-' . . ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::CANCELLATION::::>:::::::::::::: . . .': : :.:..: : :.:-:.::::>-:< : : : _........ :: ..... :: :: : : : >;-:':-.'.
CITYO 0 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
City of Clearwater ~I'
Bill Morris - Harbormaster "'<:: /"7 'TU~TOMAILSUCHNOTICESHALLIMPOSENOOBLlGATlONORLlABILlTY
25 Causeway Bl vd ~............ OF ANY)<I~ UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
Clearwater FL 33767-2604 A~ PRESENTATIVE
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