CERTIFICATE OF INSURANCE
~!~~l__~~
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
FLORIDA INSURANCE SOURCE,
AIM INSURANCE AGENCY
P.O. Box 15209
CLEARWATER, FL 34629-5209
INC.
COMPANIES AFFORDING COVERAGE
COMPANY A Program Underwri ters
LETTER
INSURED
Clearwater Group A.A.
P.O.Box 518
Clearwater, FL 34617
COMPANY B
LETTER
COMPANY C
LEITER
COMPANY D
LETTER
COMPANY E
LETTER
::all,;."g~l.t:[:[:[:[:[:::[,[",:,[:::[,::[:[:[:[,[,[:[::,[,:=::::::,:"@,:,=@:":[:[,,,::@[,[:[,:,[:[,[,[,[,,,[,[,:,[,[::,[,[:[,:::':{::'::['::::::::t::@@!{II@@[:[::[:[:[:[:[{{::::;:::!{:::::[::::::::::::::::::::{:::!:::!{:!:[:[:::::::::::::!:::::::!:!:!:!:!:!:!:!:!:!:[:!'!:!'!'!:!'[:[:['['['::"[:[::'::!:@:::{::{::::{::{:::@[:[:[:[[[:[:[:[:[:[:[:[:[:[:::[:[:[:[:[:[:::!:!:::::::::[:!'!::{:[:['[:!:[:::::[:[:[:[:[:[{:[:[:[:[:[:[:[:J:!::::::::::::{:!'!:!':'
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.
WORKER'S COMPENSAnON
AND
EMPLOYERS' LIABILITY
POLICY EFFECTIVE POLICY EXPIRATION LIMITS
DATE (MM/DDIYY) DATE (MM/DDIYY)
GENERAL AGGREGATE $ 1,000,000
11/29/94 11/29/95 PRODUCTSCOMP/OP AGG, $
PERSONAL & AnV, INJURY $ 500,000
EACH OCCURRENCE $ 500,000
FIRE DAMAGE (Any one fire) $ 50,000
MED, EXPENSE (Anyonepe~n $ 5,000
COMBINED SINGLE $
LIMIT
BODILY INJURY $
(per pe~n)
BODILY INJURY $
(per accident)
~ W~ rr
I.. , PROPERTY DAMAGE $
U)
EACH OCCURRENCE $
AGGREGATE $
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
A OENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY 94112901
CLAIMS MADE ~ OCCUR.
OWNER'S & CONTRACTOR'S PROT,
PREMISES/OPERATIO
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON.QWNED AUTOS
GARAGE LIABILITY
EXCESS LIABILITY
UMBRELLA FORM
OTHER JHt\NUMBRELlI\ FORM
DISEASE-POLICY LIMIT
DISEASE-EACH EMPLOYEE
OTHER
DESCRIPTION OF OPERAnONS/LOCAnONSIVEHICLES/SPECIAL ITEMS
City of Clearwater is additional insured pertaining to premises leased by
the insured.
:::::::: EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
City of Clearwater FEB 1 7 19~~ :~[iiiii MAIL..-!LDAYSWRITTENNOTICETOTHECERTIFICATEHOLDERNAMEDTOTHE
:::::::' LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
Risk Management CITY CURK DEPT.:::::::: LIABILITY OF ANY ND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES,
~~:.::::+:;;;aAV~C:~~?&0S~