CERTIFICATE OF INSURANCE FOR 06/03/1993-06/03/1994
PRODUCER
Mutual Insurance Agency
of Clearwater
P.o. Box 1779
Clearwater, Fl
34617
John Gay
813-446-6064
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ACORDIjJBI.I;Iilmil,I..lmEI~s.~lUmB ...1> ci$~~SIskJkD~+~~~%riX~)'....
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THIS CERTIFlCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFlCATE HOLDER. THIS CERTIFlCATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
INSURED
Marina Dental & Denture
Cl inic, P.A.
25 Causeway Blvd., Ste. 20
Clearwater, Fl
34630
COMPANY A Auto Owners
LEITER
COMPANY B
LEITER
COMPANY C
LEITER
COMPANY D
LEITER
TIllS IS TO CERTIFY TIiAT niE POUCIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO niE INSURED NAMED ABOVE FOR niE POUCY PERIOD
INDICATED, NOTWIniSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OniER DOCUMENT WIlH RESPECT TO WHICH lHIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, lHE INSURANCE AFFORDED BY lHE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL lHE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECfIVE POLICY EXPIRATION
DATE(MMIDDNY) DATE (MMIDDNY)
LIMITS
A
92-178132-00
06/03/93
06/03/94
. GENERAL AGGREGATE
. PRODUCTS-COMP/OP AGG.
. PERSONAL & ADV, INJURY
. EACH OCCURRENCE
MED. EXPENSE (Anyone pcroon)
1,000,000.
1,000,000.
50,000.
5,000.
CLAIMS MADE X 'OCCUR.
COMBINED SINGLE
LIMIT
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
PROPERTY DAMAGE
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
EACH OCCURRENCE
AGGREGATE
AND
wOI<itEft'S conII'El'iS*i'iaN-~.'
STATUTORY LIMITS
EMPLOYERS' LIABILITY
DISEASE-EACH EMPLOYEE
DESCRIPfION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS
Additional Insured: City of Clearwater
CHY CLERK DEPT.
CANCE[,L1\'I'I()N""
SHOULD ANY OF lHE ABOVE DESCRIBED POUCIES BE CANCElLED BEFORE lHE
EXPIRATION DATE lHEREOF, lHE ISSUING COMPANY WILL ENDEAVOR TO
MAIL~ DAYS WRITIEN NOTICE TO lHE CERTIFICATE HOLDER NAMED TO lHE
T F RE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGA TION OR
F ANY ND UPON lHE COMPANY, ITS AGENTS OR REPRESENTATIVES.
CER'l'FICAtE.I-IQtJ)E~.....
City of Clearwater
Harbormasters Office
25 Causeway Blvd.
Clearwater Fl 34630
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d~\.it.
JUN 0 3 1993
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