CERTIFICATE OF LIABILITY INSURANCE (5)
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CERTIFICA. E. OF LIABILITY INSU~NC~Rf&!g J CA~E4{;~~D';;s
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 THE POLICIES BELOW.
PRODUCER
Mutual Znsurance Agency
at Clearwater, Znc.
P.O. Box ~779
C~earwater PL 33757-1779
Phone: 727-446-6064 Pax:727-442-9751
INSURERS AFFORDING COVERAGE
INSURED
Marina Dental _ Denture
Clinic, P.A.
25 Causeway Blvd., Ste. 20
Clearwater PL 33767
INSURER A;
INSURER B:
INSURER c:
INSURER 0:
INSURER E:
Auto Owners
COVERAGES
TI1E 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 CERTlFICATE 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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID ClAiMS.
_. &~fIf~~,t~e ! 1'~.tTE MM/DDIYY) - - - --~------.-.._-
'rl: TYPE OF INSURANCE POUCY NUMBER LIMITS
~EAAL LIABILITY EACH OCCURRENCE $ 1000000
A X COMMERCIAL GENERAl UABILITY 92-178J.32-00 06/03/05 06/03/06 FIRE DAMAGE (Any one fll'e) $ 50000
I CLAIMS MADE [i] OCCUR MED EXP (Anyone person) $ 5000
:-- PERSONAL & ADV INJURY $1000000
GENERAL AGGREGATE S 1000000
I--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
II POLICY n ~r8i n LOC
AUTOMOBILE LIAIlILlTY COMBINED SINGLE LIMIT $
I-- (Ea accident)
ANY AUTO
~
ALL OWNED AUTDS BODILY INJURY S
- (Per person)
SCHEDULED AUTOS i
- i
HIRED AUTOS BODILY INJURY
- (Per accident) S
NON-OWNED AUTOS
-
- -- PROPERTY DAMAGE S
(Per accidenl)
RE LIABILITY AUTO ONLY - EA ACCIDENT S
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG S
DESS LIABILITY EACH OCCURRENCE S
OCCUR 0 ClAiMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I TORYLIMrTSI IU~~.
EMPLOYERS" L1ABIUTY
E.L. EACH ACCIDENT S
, E,L. DISEASE. EAEMPI.OYEE $
,
E,L, DISEASE. POLICY LIIlAIT $
OTHER
A Personal Prop. REPL. COST 50,000.
DESCRIPTION OF OPERATIONSlLOCATlONSNEHICLESlEXCLUSlONS ADDED BY ENDORSEMENTISPECIAL PAOVI$lONS
City of C1earwater is named as Additional Znsured.
Additional insured: City of Clearwater
CERTIFICATE HOLDER I N I ADOITIONALlNSUREO; IHSUIUOR LEnER: CANCELLATION
CZTI010 SHDULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEfORE THE EXPIRATION
OATE THEREOF, THE ISSUING INSURER WILL ENDEAIIOR TD MAlL ~ OAYS WRITTEN
City of Clearwater NOTICE TonE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL
FX 462-6957
Harbormasters Office IMPOSE NO OBLIGATION OR L1ABILllY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
I 25 Causeway Blvd. REPRESENTATIVES. J
I Clearwater FL 33767 AUTHORIZED Rep(T~ ~~
John Gav '- ~V
ACORD 25-S (7/97) /l (J ~ACORD CORPORATION 1988
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