CERTIFICATE OF INSURANCE FOR 06/03/1996-06/03/1997
ACORD
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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)
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