CERTIFICATE OF LIABILITY INSURANCE (3)
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Apr-22-03 02:56P
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PRODUCER - THIS CERTIFICATE IS ISSlJEDASA MATTEROi= INFORMATION
Mutual J:nsurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
at Clearwater, Xnc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P . 0 . Box 177 9 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater l"L 33757-1779 COMPANIES AFFORDING COVERAGE
John Gay COMPANY I
p!:o-".!!.~g H_7.-:.4.~-:~Q.9~_..-.f'!!'f-!.o 727-442-9751 A Auto Owners
INSURED
COMPANY
B
Marina Dental & Denture
Clinic, P.A.
25 Cauaeway Blvd., Ste. 20
Clearwater FL 33767
COMPANY
C
COMPANY
D
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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 I lYPE OF INSURANCE I POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
'- TR : . OATE (MMIDDIVY) DATE (MMlDDlVYI
LIMITS
GENERAL I..IABILIT't GeNERAl AGGREGATE S 1000000
~ 06/03/03 06/03/04
A X COMMERCIAL GENERAL. LIABILITY 92-178132-00 PROOUCTS . COMP!OP AGG S
I CLAIMS MADE W OCCUR PERSONAL .. AOV INJURY S 1000000
OWNER'S" CONTRACTOR'S PROT EACH OCCURRENCE $ 1000000
~
~ FIRE DAMAGE (Anyone nre) S 50000
MED EXP (Anyone peqon) S 5000
AUTOMOBILE LIABILllY
I-- COMBINED SINGLE LIMIT S
I-- ANY AUTO
ALL OWNED AUTOS BODILY INJURY
l- (Per p818Ol'l) S
SCHEDULED AUTOS
I--
HIRED AUTOS BOOIL Y INJURY
. -,-.1 (Per acddenl) S
\---1 NON.OWNED AUTOS
PROPERTY DAMAGE S
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT S
-
ANY AUTO OTHER THAN AUTO ONLY: .:': .. ,
-
EACH ACCIDENT $
-
AGGREGATE S
EXCESS LIABILITY EACH OCCURRENCE S
~ UM8REL~ FORM AGGREGATE S
OTHER THAN UM8REL~ FORM S
I WORKERS COMPENSATION AND jM:_STATU- I 10J~. ...
TOR~'n~ITS '......,...
: EMPLOYERS' L1ABtUlY EL EACH ACCIDENT $
THE PROPRIETOR! RINCL EL DISEASE. POliCY LIMIT $
PARTNERSlEXECUTIVE
OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE $
OTHER
A Personal Prop. RBPL. COS'l' 50,000.
DESCRIPTION OF OPERATIONSlLOCATlONSIVEHIClES/SPECIAl.ITEMS
City of Clearwater is named as Additional XDsured.
Additional insured: City of Clearwater
CERTIFICATE.HOLDER:.:..'..... .
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CI'l'10 1 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
li- DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
BUT FAILURE TO MAIL SUCH NOTICE SliALL IMPOSE NO OBLIGATION OR L1ABILllY
OF ANY KIND UPON THE COMPANY, ITS AGeNTS OR REPRESENTATIVES.
AUTHORIZED REPRES ATIV
City of Clearwater
FX 462-6957
Harbor.masters Office
25 Causeway Blvd.
Clearwater PL 33767
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J()hn.Gay
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