CERTIFICATE OF LIABILITY INSURANCE (4)
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ACORDTM
CERTIFICATE OF LIABILITY INSURANCE
MLG DA TE
U022 07 29 2008
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.
ROWN & BROWN OF FLORIDA INC/PHS
24605 P: (866)467-8730 F: (877)538-8526
PO BOX 29611
CHARLOTTE NC 28229
INSURERS AFFORDING COVERAGE
INSURERA:Hartford Ins Co of the Southeast
INSURERB: Hartford Underwriters Ins Co
INSURED
WILLA CARSON HEALTH RESOURCE CENTER
1108 N. MARTIN LUTHER KING JR AVE.
CLEARWATER FL 33755
COVERAGES
INSURER c:
INSURER D:
INSURER E:
------------ --- - - ------ ----------- ------- --I
THE POLlCIE::;-()FINSuFfANCE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLICY NUMBER :f]Ng:f{%,~Jr.f "g~'fr(;::'t~~J?~r LIMITS
LTR
~ERAL LIABILITY EACH OCCURRENCE $1,000,000
A - 3MMERCIAL GENERAL LIABILITY 21 SBM RQ7532 05/02/08 05/02/09 FIRE DAMAGE (Anyone fire) $300, 000
- CLAIMS MADE !Xl OCCUR MED EXP (Anyone person) $10,000
4 General Liab PERSONAL & ADV INJURY $1,000 000
---- ,----'- . ',. . ....' . u___ --~-_._--_. ----~---- .-.- ______H_" __ - $2;o-o'cy, mrn- I
- GENERAL AGGREGATE
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GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 I
~ POLICY n j~gT !Xl LOC I
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~OMOBILE LIABILITY I
COMBINED SINGLE LIMIT $1,000,000 I
A ANY AUTO 21 SBM RQ7532 05/02/08 05/02/09 (Ea accident)
- I
- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
-
.x HIRED AUTOS BODILY INJURY
$
.x NON-OWNED AUTOS (Per accident) ,
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- r,;)r;'~l :~VJ: r'" PROPERTY DAMAGE $
, " :~ ~ j (Per accident)
1AGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO rr"') 0 ~ 2008 OTHER THAN EA ACC $
,-' _..I AUTO ONLY: I
AGG $
EXCESS LIABILITY EACH OCCURRENCE $ !
~. OCCUR l.J CLAIMS MADE OFf:"':;AI RE< ORDS ANi) AGGREGATE $ ,
LEGiSLA TIVE ~ RVeS DEPT $
==i DEDUCTIBLE $
RETENTION $ $
X I T~~ir~~s I IOJ~- !
WORKERS COMPENSA TION AND
B EMPLOYERS' LIABILITY 21 WEC GC3515 10/03/07 10/03/08 $100,000
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE $100,000
E.L. DISEASE - POLICY LIMIT $500,000
OTHER
--I--- .- --. - -- -- - - "--.-- ------,-~ -- _..._---,-- ~-~ -,,-- , - ------ -- -- '--------- ,- - -- -. ---,-,,----- .- -.-..--.. --
DESCRIPTION OF OPERA TIONSlLOCA TIONSNEHlCLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Those usual to the Insured's Operations.
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
City of Clearwater Florida 30 DAYS WRITTEN NOTICE (10 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE
Attn: Housing Division HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO
OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
.12 S OSCEOLA AVE REPRESENT A TIVES.
LEARWATER,FL,33756 A~J:;;t7.TI":.
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ACORD 25-S (7/97)
@ ACORD CORPORATION 1988