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CERTIFICATE OF INSURANCE FOR 06/03/1996-06/03/1997 ACORD .....<f~R~!I!~!-.t~m~i~~~.~~Qf,...i. ........................"......................................g$H.......~s. l~sJik..;~6i~%ri#g...,.""...... 04/08/96 THIS CERTIFICATE IS ISSUED 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 TilE POLICIES BELOW. PRODUCER Mutual Insurance Agency of Clearwater P.o. Box 1779 Clearwater, Fl 34617 John Gay 813-446-6064 COMPANIES AFFORDING COVERAGE COVERAGES llIIS IS TO CERTIFY llIA T THE POUCIES OF INSURANCE US TED BELOW HAVE BEEN ISSUED TO llIE INSURED NAMED ABOVE FOR llIE POUCY PERIOD INDICATED, NOTW!llISTANDlNG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR 01llER DOCUMENT WIlli RESPECT TO WHICH 1lI1S CERTIACA TE MAYBE ISSUED OR MAY PERTAIN, llIE INSURANCE AffORDED BY llIE POUCIES DESCRIBED HEREIN IS SUBJECT TO AlL llIE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES, UMITS SHOWN MA Y HAVE BEEN REDUCED BY PAID CIAIMS. COMPANY A Auto Owners LETTER COMPANY B LEITER COMPANY C LETTER COMPANY D LEITER COMPANY E LETTER INSURED Marina Dental & Denture Cl inic, P.A. 25 Causeway Blvd., Ste. 20 Clearwater, Fl 34630 CO LTR TYPE OF INSURANCE 92-178132-00 06/03/96 06/03/97 : GENERAL AGGREGATE : PRODUCTS-COM PlOP AGG. : PERSONAL & ADV, INJURY : EACH OCCURRENCE : FIRE DAMAGE (Any one r",,) $ . MED, EXPENSE (Anyone person) $ 1000000 POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE(MMIDD/YY) DATE (MMIDD/YY) . LIMITS GENERAL LIABILITY A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE X OCCUR. OWNER'S & CONTRACTOR'S PROTo AlfI'OMOBILE UAIllLITY ANY AlfI'O ALL OWNED AlfI'OS SCIlEOULED AlJraS IIlRED AlfI'OS NON-OWNED AlfI'OS GARAGE LIABILITY 1000000 1000000 50000 5000 COMBINED SINGLE LIMIT BODILY INJUR Y (Per pe ncn) BODILY INJURY (Per accident) $ PROPERTY DAMAGE EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE AGGREGATE $ $ AND EACH ACCIDENT $ DISEASE-POLICY LIMIT $ DISEASE-EACH EMPLOYEE $ WORKER'S COMPENSATION EMPLOYERS' LIABILITY OTHER A Personal Prop. repl. cost 50,000. DESCRIPTION OF OPERATIONStLOCATlONSNEIIICLESISPECIAL ITEMS Additional insured: City of Clearwater City of Clearwater Harbormasters Office 25 Causeway Blvd. Clearwater Fl 34630 SHOULD ANY OF 11IE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE llIE EXPIRATION DATE llIEREOF. llIE ISSUING COMPANY WIlL ENDEAVOR TO MAIL~ DAYS WRITfEN NOTICE TO llIE CERTIACATE HOLDER NAMED TO TIlE LEFf, BUT FAILURE TO MAIL SUCH NOTICE SHAlL IMPOSE NO OBUGA TION OR TV . Y KIND UPON 11IE COMPANY, ITS AGENTS OR REPRESENTATIVES, ACORD2S"S (7/90) Dc., f2iS!<-