CERTIFICATE OF LIABILITY INSURANCE (4)
~~(
~-ACORDTM CERTIFICATE OF LIABILITY INSURANCE
PRODUCER
7
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.
INSURERS AFFORDING COVERAGE
AIM Insurance Group, Inc.
AIM INSURANCE AGENCY
P.O. Box 860
INSURED
Clearwater Group A.A.
P.O.Box 518
Clearwater, FL 33757
INSURER A:
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 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,
I~.f: TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
A GENERAL LIABILITY CPS03S080S 12/08/2001 12/08/2002 EACH OCCURRENCE $
I--
~ 3MMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $
CLAIMS MADE W OCCUR MED EXP (Anyone person) $ 5DDD
I--
~ PERSONAL & ADV INJURY $
f-- GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APFl PER: PRODUCTS. COMP/OP AGG $
n POLICY n ~~gT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
I-- $
ANY AUTO (Ea accident)
I--
ALL OWNED AUTOS BODILY INJURY
I-- $
SCHEDULED AUTOS (Per personl
f--
HIRED AUTOS BODILY INJURY
- $
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
=:J' OCCUR D CLAIMS MADE AGGREGATE $
$
=1 DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I Tvy,9,~:~I.~;.. I IOJ~-
EMPLOYERS' LIABILITY
E,L, EACH ACCIDENT $
-- 1----- ---- ------..---- ----- --'--- ..-.---'--------..- .._---------~---- --- ---- ------ --.--- -- ---------- -- -- --
E,L. DISEASE, EA EMPLOYEE $
E,L. DISEASE, POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
City of Clearwater is hereby named as Additional Insured, as their interest may appear.
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER; CANCELLATION 1 n_"_.. -- . . #__ "T___ .... F P....'"
Earl Barrett SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
Real Estate Services Manager NOTICE TO THE CERTIFICATE HOLDER NA:rO THE LEFT, BUT FAILURE TO DO SO SHALL
P.O. Box 4748 IMPOSE NO OBLIGATION or\ABILlTY OF A ~rD UPON THE INSURER, ITS AGENTS OR
Clearwater, FL 33758-4748 of REPRES~TATIVES, I' / ) J
Aun ~ REPRES! fH)iA 1 IVE .c7f\ V,'- r
I '.-/ . ()t....A A I 'J /JALf\~/~~"'T.7
ACORD 25-S (7/97) ~ '- ~ "7 '7 C> ACORD CO~RATION 1988