CERTIFICATE OF LIABILITY INSURANCE (4)
Apr-20-04 lO:55A
P.Ol
ACORD.
CERTIFICATE OF LIABILITY INSURANCeuf&!~ 04 20/04
THIS CERTIFICATE IS ISSUED AS A MAITER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
PRODUCER
Mutual Insurance Agency
at Clearwater, Inc.
P.O. Box 1779
Clearwater FL 33757-1779
Phone:727-446-6064 Bax:727-442-9751
INSURERS AFFORDING COVERAGE
INSURED
Marina Dental & Denture
Cl n1e, P.A.
25 Causeway Blvd.~ ste. 20
Clearwater FL 33707
INSURER A: Auto OWners
INSURER B:
INSURER C;
INSURER 0:
INSURER E:
COVERAGES
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 W.TH 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
POLICIE&. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLA/US. DATE 'IIMID~
'('1M TYPE OF INSURANCE POUCY NUMBER DXTtlllMlOOnm ' UIIITS
~NEIlAL UABlLITY EACH OCCURRENCE $ 1000000
A X COMMERCIAL GENERAL LIABILITY 92-178132-00 06/03/04 06/03/05 FIRE DAMAGE (Any an8 ftr8) S 50000
I CLAIMS MADE [i] OCCUR MEO EXP (Any one peraoo) $ 5000
PERSONAL & ADV INJURY S 1000000
- $ 1000000
GENERAL AGGREGATE
'--
GEN'LAGGREGATE LIMIT APnS PER: PRODUCTS - COMPIOP AGG $
n POlICY n ~~ I..OC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S
f..- (Ell -.dcIent)
--- ANY AUTO
ALL OWNED AUTOS BODLY INJURY S
f..- (Per P81"1Of1)
- SCHEDULED AUTOS
I..- ~IRED AUTOS BODILY INJURY
(Per .cddent) S
NON-OWNED AUTOS
~
~ PROPERTY DAMAGE S
(Per lICCIdent)
GAtIlAGE UABILlT'f AUTO ONLY - EA ACCIDENT $
R -ANY AUTO OTHER THAN EAPCC $
AUTO ONLY: AGo $
DCeaS LlA8ILITY EAai OCCURRENCE S
=:J OCCUR 0 CLAIMS MADE AGGREGATE $
$
==i DEDUCTIBLE $
RETENTION $ S
WORKERS COIIIIPl!!N8ATlON AND I TORY LIMITS I 10m-
EMPLOYERS" LIABIUTY E.L. EACH ACCIDENT
$
E,L. DISEASE. EA EMPLOYEE S
E.L. DISEASE. POLICY LIMIT $
OTHER
A Perllonal PZ'op. RBPL. COST 50,000.
DESCRIPTION Of OPERA1IOII8ILOCA TIONSlVEHICLEBlEXCLUSION8 ADDED BY ENOClRSEMENTISPECIAL. PROVISIONS
City of Cle~ater i8 named as Additional Insured.
.'
Additional insured: City of Clearwater
CERTIFICATE HOLDER TN I ADDmONAL INSURED; INaURER lETTER: CANCELLATION
CJ:T1010 SHOULD ANYOF THE ABOVE DeSCRIBeD POLICIES BE CANCEUED BEFORE THE EXPIRAnOl\
DATE THEREOF. THE ISSUING INSURER WILL ENDEAIfOR TO MAlL ~DAYS WRITTEN
City of Clearwater NOnCE TO THE CERTIFICATE HOLDER NAilED TO THE LEFT. BUT FAILURE TO DO so SHALL
11'% 462-6957
Harborm&ster8 Office IMPOSE NO OBUGAnON OR LIABILJTY OF ANY IUND UPON THE INSURER. ns AGENTS OR
2S Causeway Blvd. REPRESENTATIVES.
C1earwater FL 33767 AUtHORIZED ~~E _~
I John Gav l / T Y
ACORD 25-5 (7/97) (I 1./ (/:)ACORD CORPORATION 1988
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