CERTIFICATE OF INSURANCE FOR 06-03-1997-06-03-1998
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THIS CERTIFICATE IS IS~UED 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
DATE IMM/DDNYI
97
PRODUCER
Mutual Insurance Agency
of Clearwater, Inc.
P .0. Box 17 7 9
Clearwater FL 34617-1779
John Gay
Phone No. 813-446-6064 F8x No. 813-442-9751
INSURED
COMPANY
A
Auto Owners
COMPANY
B
RECEIVED R E C E IVE D
APR 1 0 1997
Marina Dental & Denture
Clinic, P.A.
25 Causeway Blvd., ste. 20
Clearwater FL 34630
COMPANY
C
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BElOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICA TED, 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 EXPIRAnON
DATE lMMlDDIYYI DATE lMMIDDNYI
UMITS
GENERAL UABlUTY
A X COMMERCIALGENERAlUABILITY 92-178132-00
CLAIMS MADE [!] OCCUR
OWNER'S & CONTRACTOR'S PROT
GENERAL AGGREGATE
$ 1000000
06/03/97
06/03/98 PRODUCTS-COMP/OPAGG $
PERSONAL & ADV INJURY $ 1000000
EACH OCCURRENCE $ 1000000
FIRE DAMAGE (Anyone fire) $ 50000
MED EXP (Anyone person) $ 5000
AUTOMOBILE UABlUTY
ANY AUTO
AlL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
COMBINED SINGLE LIMIT
GARAGE UABlUTY
ANY AUTO
BODILY INJURY $
(Per person)
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE
EACH OCCURRENCE
AGGREGATE
EXCESS UABIUTY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' UABlUTY
- -- ~Tj,jEPI'.OPR!ErCR/-
PARTNERS/EXECUTIVE
OFFICERS ARE:
OTHER
- tNCL-
s..~.\SE - PCl:.cv-t:M:T-
~
...,._____n____
EXCL
EL DISEASE - EA EMPLOYEE
$
A Personal Prop.
repl. cost
50,000.
DESCRIPTION OF OPERAnONSILOCAnONSNEHlCLES/SPECIAlITBIIIS
Additional insured: City of Clearwater
City of Clearwater
Barbormasters Office
25 Causeway Blvd.
Clearwater FL 34630
THE COMPANY,ITS AGENTS OR REPRESENTAnVES.
ENTAnVE
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