CERTIFICATE OF LIABILITY INSURANCE
PRODUCER THIS CERTIFICATE IS ISSVED AS A MATTER OF INFORMATION
Mutual Insurance Agency ,"- ONLY AND CONFERS NO~IGHTS UPON THE CERTIFICATE
of Clearwater, Inc. HOLDER, THIS CERTIFiCATE DOES NOT AMEND. EXTEND OR
P .0. Box 1779 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater FL 33757-1779 COMPANIES AFFORDING COVERAGE
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
Clearwate:[., FL 33767
COMPANY
C
COMPANY
D
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
POUCY NUMBER
POUCY EFFECTIVE POUCY EXPIRATION
DATE (MMIDDIYYI DATE (MMIDDIYYI
UMITS
GENERAL UABlUTY
COMMERCiAl GENERAL LIABILITY 92-178132-00
CLAIMS MADE [!] OCCUR
OWNER'S & CONTRACTOR'S PROT
GENERAl AGGREGATE
$ 1000000
A
06/03/00
06/03/01 PRODUCTS - COMP/OP AGG $
PERSONAL & ADV INJURY $ 1000000
EACH OCCURRENCE $ 1000000
FIRE DAMAGE (Anyone lire) $ 50000
MED EXP (Anyone person) $ 5000
AUTOMOBILE UABIUTY
ANY AUTO
AlL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
COMBINED SINGLE LIMIT
GARAGE UABIUTY
ANY AUTO
BODILY INJURY $
(Per person)
BODILY INJURY $
(Per occident)
PROPERTY DAMAGE
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EACH ACCIDENT
AGGREGATE $
EACH OCCURRENCE $
AGGREGATE $
EXCESS UABlUTY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' UABIUTY
THE PROPRIETOR/
-_. .PARTl'fERSlEXEClit1VY.--
OFFICERS ARE:
OTHER
.INCL 0-__.__
EXCL
ELDISEA~E_ - POLICY pMIT
EL DISEASE - EA EMPLOYEE $
A Personal Prop.
repl. cost
50,000.
DESCRIPTION OF OPERATlONSILOCATlONSNEHlCLES/SPECIAL ITEMS
Additional insured: City of Clearwater
CIT1010
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELlED BEFORE THE
City of Clearwater
Harbormasters Office
25 Causeway Blvd.
Clearwater FL 33767
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
...!!L. DAYS WRITTEN NOTICE TO THE CERTI~~~EQ T~ ~HL..~
BUT FAILURE TO MAIL SUCH NOTICE SHALLIM"~~~~
ND PON THE COMPANY,ITS AGENTS OR REPRESENTATIVES.
ESENTATlVE
A