CERTIFICATE OF LIABILITY INSURANCE
ACORD~
CERTIFICA E OF LIABILITY INSU
j
PRODUCER
The Connelly Insurance Group
630 Chestnut Street
P.O. Box 2456
Clearwater FL 33757-2456
Phone: 727-461-6044 Fax:727-442-7695
Nce OPID A
~ONGC-2 05/16/01
THIS CERTIFICATE IS SUED 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.
EACH OCCURRENCE $ 1,000,000
10/15/01 FIRE DAMAGE (Any one fire) $ 200,000
-~ -----~~------ --MEDEXP-{Anyone jlefSoot-- - -$--J.-{h-~._--
PERSONAL & ADV INJURY $ 1, 000 , 000
GENERAL AGGREGATE $ 3, 000, 000
PRODUCTS - COMP/OP AGG $ 3 , 0 0 0 , 0 0 0
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ...J.L 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.
AUTHORIZEDREPR~~E .i )f'/ ,1"\.1 ,I, 1117/), /
John P. Co ;fM-/l./U rVVl..tX.Jtlx.
U @ACORDCORPORATION 1988
INSURERS AFFORDING COVERAGE
INSURED
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
General Insurance Company
SAFECO Insurance Company
The Long Center
1501 N. Belcher Road, Ste. 225
Clearwater FL 34625
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.
1~1~ TYPE OF INSURANCE POLICY NUMBER b~~\fMX~Bw')'YE P6'.k+i~~?N LIMITS
GENERAL LIABILITY
f--
A X COMMERCIAL GENERAL LIABILITY CP 77 7 12 5 8
... - --- .. CliiIMSlilADE't!] OCCUI< --- -,-- ,-- -
10/15/00
f---
A
f--
GEN'l AGGREGATE LIMIT APPLIES PER:
n nPRO. n
POLICY JECT lOC
AUTOMOBILE LIABILITY
-
X ANY AUTO
-
ALL OWNED AUTOS
COMBINED SINGLE LIMIT
BA7771258 10/15/00 10/15/01 (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
UL7771258 10/15/00 10/15/01 AGGREGATE
-
-
-
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
-
X Comp $100 ded
-
X Coll $250 ded
GARAGE LIABILITY
=l ANY AUTO
EXCESS LIABILITY
B ~ OCCUR D CLAIMS MADE
I DEDUCTIBLE
I RETENTION $
.--- WORKERS-COMPENS~TIONANrr
EMPLOYERS' LIABILITY
.--
I TORY L1MrrS i 'iU~~-
E.L. EACH ACCIDENT
_ .c.
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESJEXCLUSIONS ADDEO BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER
I N I ADDITIONAL INSURED; INSURER LETTER:
CANCELLATION
CLEAR15
City of Clearwater
P.O. Box 4748
Clearwater, FL 33758-4748
I
ACORD 25-S (7/97)
Ce.
V ./,)..
il1Z,,-Cv:?.j f--JL-C- I i<--t s Ie
DATE (MM/DD/YY)
$1,000,000
$
$
$
$
$
$
$5,000,000
$5,000,000
$
$
$
".----.
$