CERTIFICATE OF LIABILITY INSURANCE (2)
CERTIFICA,J,E OF LIABILITY INSU~^, Nce OPID DATE (MM/DDfYY)
. I"V'" ~NGC-2 10/17/01
PRODUCER ~ - THIS CERTIFICATE IS 'SUED AS A MATTER 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
Phone: 727-461-6044 Fax:727-442-7695
ACORDN
INSURERS AFFORDING COVERAGE
INSURED
The Long Center
1501 N. Belcher Road, Ste. 225
Clearwater FL 34625
INSURER A:
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
General Insurance Company
SAFE CO Insurance Company
Auto Owners
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
LTR
TYPE OF INSURANCE
POLICY NUMBER
~~~WiM1f,b~mYE P~l-+~~~~r6'tJ}?N
LIMITS
GENERAL LIABILITY
e--
A X COMMERCIAL GENERAL LIABILITY
e--- [!]
e--e-] CLAIMS MADE X OCCUR
e--- -.
e--
GEN'L AGGREGATE LIMIT APPLIES PER:
II n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY
e--
C ~ ANY AUTO
e--- ALL OWNED AUTOS
SCHEDULED AUTOS
e--
HIRED AUTOS
e--
NON-OWNED AUTOS
f--
~ Comp $100 ded
X Coll $250 ded
GARAGE LIABILITY
.=~ ANY AUTO
EXCESS LIABILITY
B o OCCUR D CLAIMS MADE
CP7771258
EACH OCCURRENCE $ 1,000,000
10/15/01 10/15/02 FIRE DAMAGE (Anyone fire) $200,000
MED EXP (Anyone person) $ 10,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 3 , 000 , 000
PRODUCTS - COMP/OP AGG $ 3,000,000
COMBINED SINGLE LIMIT $1,000,000
10/15/01 10/15/02 (Ea accident)
BODILY INJURY $
(Per person)
.-
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE $
(Per accident)
AUTO ONLY. EA ACCIDENT $ ----
OTHER THAN EA ACC $
.- --
AUTO ONLY: AGG $
EACH OCCURRENCE $.5,000,000
--
10/15/01 10/15/02 AGGREGATE $5,000,000
$
TO BE DETERMINED
UL7771258
R DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
-.
$
$
I t'5R~TdWTS I IUJ~-
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
.---
.i..-
-.-- .....-..-
-
E.L. DISEASE - POLICY LIMIT $
--- ..
OTHER
I
----I\/r--......
............. .....-v.........
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
OCT 1 9 ?On1
RISK MANAGEMENT
CERTIFICATE HOLDER
I N i ADDITIONAL INSURED; INSURER LETTER:
CLEAR15
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE 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. '/'. f\
AUTHORIZED REPRESENTATIVE I C) 1 _. / ' ..L. AI 0 /J /
John P. Connelly ~ JrJ/U V
I, _, ;, :;.' :.' ~ "'ACC/R{fl~bRPORATI01<r
City of Clearwater
P.O. Box 4748
Clearwater, FL 33758-4748
ACORD 25-S (7/97) 0 e,~ G \ N A L C' ( \"'\ C l ~ \ c..
C'.. c: " fA (z'iL5 I (( ( 5 IL