CERTIFICATE OF LIABILITY INSURANCE (2)
ACORD.
CER"TIFICA1'eOFLIAI3ILITYINSUR~NCEcsRPs> ... DATE (MMlDDIYY) ..
...... .......................... .................. ..,'. ..... ....... ........ .............. ......... ..... .......... ................................. ..\'\1 ..... .... ....... .MA~I~,,:2... 04/10/01..
THIS CERTIFICATE lS"lSSUED 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. 727-446-6064 Fax No. 727-442-9751
INSURED
COMPANY
A
Auto Owners
COMPANY
B
Marina Dental & Denture
Clinic, P.A.
25 Causeway Blvd., Ste. 20
Clearwater FL 33767
COMPANY
C
COMPANY
D
I.."'.~.~.":",'.~.':":' .,
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,
..:
...
..........::::::::.::.::::::
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 92-178132-00
I CLAIMS MADE [!] OCCUR
OWNER'S & CONTRACTOR'S PROT .
-
-
AUTOMOBILE LIABILITY
-
ANY AUTO
-
ALL OWNED AUTOS
-
SCHEDULED AUTOS
-
HIRED AUTOS
-
NON-OWNED AUTOS
-
-
GARAGE LIABILITY
-
ANY AUTO
-
-
EXCESS LIABILITY
R UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
THE PROPRIETOR! RINCL
PARTNERSlEXECUTIVE
OFFICERS ARE: EXCL
OTHER
A Personal Prop. REPL. COST
06/03/01
06/03/02
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
PERSONAL & ADV INJURY
EACH OCCURRENCE
FIRE DAMAGE (Anyone fire)
MED EXP (Anyone person)
s 1000000
s
s 1000000
s 1000000
s 50000
s 5000
COMBINED SINGLE LIMIT S
BODILY INJURY S
(Per person)
BODILY INJURY S
(Per accident)
PROPERTY DAMAGE S
AUTO ONLY. EA ACCIDENT S
OTHER THAN AUTO ONLY:
EACH ACCIDENT S
AGGREGATE S
EACH OCCURRENCE S
AGGREGATE $
$
IOTH-
ER
$
$
EL DISEASE - EA EMPLOYEE $
!WC STATU- I
tORY LIMITS
EL EACH ACCIDENT
EL DISEASE - POLICY LIMIT
IRE..' 'C".'!"'I. ., ..... l"'l
, L:..~ \i cu
APR 1 a ZOOl
50,000.
DESCRIPTION OF OPERA TIONSILOCA TIONSNEHICLESlSPECIAL ITEMS
ClTY CLERK DEPARTMENT
Additional insured: City of Clearwater
. CI:RT:I~AT~ HOLDER.:.::..
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.... CANCELLA:Tlot-F:: . .
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:ACO~P::~$$:{~I$$}::: . .
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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,
-
~ ,/,R~ MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
~ OF ANY KI~D uJ>oN THE COMPANY, ITS AGENTS OR REPRESENTATIVES,
~RIZ PRESENTATIVE
J Y
.. ........................
.. .... '.. ... . <::<::::::<:: <::::<.:::....., :<::::::::::::::~:AC!:lf:{PQl>.RPQMrION}~$8:<
/
CIT1010
City of Clearwater
Harbormasters Office
25 Causeway Blvd.
Clearwater FL 33767