CERTIFICATE OF LIABILITY INSURANCE (2)
~
PRODUCER
7
THIS CERTIFICATE IS ISSUED AS A MAlTER 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.
COMPANIES AFFORDING COVERAGE
AIlI(. InB~ance Group, Inc.
AIM INSURANCE AGENCY
P.O. Box 15209
CLEARWATER, FL 33766
COMPANY
A SCOTTSDALE INS CO
INSURED
Clearwater Group A.A.
P.O.Box 518
Clearwater, FL 33757
COMPANY
B
COMPANY
C
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
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DD/YY) DATE (MM/DD/YY)
LIMITS
AU ~ENERAI(iABTLlTV- . .cPSO:U:i1966.. .
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE [i] OCCUR
OWNER'S & CONTRACTOR'S PROT
X PREMISES/OPERATIO
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
"T270Ff7H99 12108/2000 GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
PERSONAL & ADV INJURY $
EACH OCCURRENCE $
FIRE DAMAGE (Anyone fire) $
MED EXP (Anyone person) $
1000000
500000
500000
500000
100000
5000
COMBINED SINGLE LIMIT $
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE $
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT $
OTHER THAN AUTO ONLY:
EACH ACCIDENT
AGGREGATE
EACH OCCURRENCE
AGGREGATE
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
THE PROPRIETOR! INCL
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL
OTHER
$
EL DISEASE - POLICY LIMIT $
EL DISEASE - EA EMPLOYEE $
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEUED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
R REPRESENTATIVES.
City or Clearwater
Attn: Earl Barrett Eng. Dept.
P. O. Box 4748
Clearwater, FL 34618
I
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