CERTIFICATE OF INSURANCE FOR 06-03-1999-06-03-2000
... CERTIFICATf OF LIABILITY INSURPfJCE
ACORD... CSR PS DATE (MMIDDIYYI
MARIN-2 04/12/99
PAODUCBl THIS CERTIFICATE IS I~UEO AS A MATTER OF INFORMATION
Mutual Insurance Agency ONl Y AND CONFERS NO RIGHTS UPON 1 HE CERTIFICATE
of Clearwater, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
P.O. Box 1779 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
Clearwater FL 33757-1779 COMPANIES AFFORDING COVERAGE
John Gay COMPANY
A Auto Owners
Phone No, 727-446-6064 Fax No.7 27 -442-97 51
INSURED COMPANY
B
~~~~~-.""". --
~~r~~"',;,'f'~"." COMPANY
. .. '".inrc~l>:A~l,..~.P,llture. .. C
25 Causeway Blvd. I Ste. 20 COMPANY
Clearwater FL 33161 0
COVERAGES
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 TYPE OF INSURANCE POUCY NUMBBI POUCY EFFECTIVE POUCY EXPIRATION UMITS
LTR DATE IMMIDDIYYI DATE (MMIDDIYYI
~ERAL UABlUTY ~9!(~~~ GENERAL AGGREGATE $1000000
A ~ COMMERCIAL GENERAL LIABILITY 92-118132-00 06/03/99 PRODUCTS - COMPIOP AGG $
=:J CLAIMS MADE [i] OCCUR .
PERSONAL & ADV INJURY $ 1000000
>-- .--
OWNER'S & CONTRACTOR'S PROT I EACH OCCURRENCE $1000000
f- !
I I FIRE DAMAGE (Anyone 'Ire I $50000
>-- ~.
I M ED EXP (Anyone perl on) $ 5000
~TOMOBlLE UAB1UTY ! I COMBINED SINGLE LIMIT $
ANY AUTO
>--
>-- ALL OWNED AUTOS BODILY INJURY
(Per per.on) $
SCHEDULED AUTOS
I--
>-- HIRED AUTOS BODILY INJ URY
IPer eccidenll $
NON-OWNED AUTOS
I--
>-- PROPERTY DAMAGE $
GARAGE UA8IUTY AUTO ONLY. EA ACCIDENT $
>--
ANY AUTO OTHER THAN AUTO ONLY:
f- I
EACH ACCIDENT $
>-- -_.- I
AGGREGATE $
EXCESS UABlUTY EACH OCCURRENCE $
R UMBRELLA FORM AGGREGATE $
--
OTHER THAN UMBRELLA FORM $
WORKERS COMPENSATION AND I WC STATU- I IOl~'
TORY lIMITS
EMPlOYERS' UABlUTY
EL EACH ACCIDENT ~-
.-'-------- ---
THE PROPRIETOR! RINCL EL DISEASE. POLICY LIMIT $
PARTN ERs/EXECUTIVE -
OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE $
OTHBI
A Personal Prop. repl. cost 50,000.
I
I
I
OESCIUPTlON OF OPERATlONS/LOCATlONSNEHlCLES/SPECIALITEMS
~la"'ln8urecl* Ci\V of Clearwater
l:ti:..._........ ~ \.,_.' . ,..e. c' '" .'_ ;
CERTlFICA TE HOLDER CANCElLA nON
CIT1010 SHOULD MY OF THE ABOVE DESCIUBED POUCIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
City Clearwater ..!.Q.... OAYS WIUTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
of BUT FAlL~ TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUOATION OR UABlUTY
Barbormasters Office .~ ~~N THE COMPMY,ITS AGENTS OR REPRESENTATIVES,
25 Causeway Blvd.
Clearwater FL~ ~H01U7 7SENTATlVE
'3,-7(.7 I~ay)
ACORD 25-S (1195) @ACORD CORPORATION 1988
\/