CERTIFICATE OF LIABILITY INSURANCE
.,
. s"ACJjib:~pERTiFi~;'E.OF LIABILITY INSURANUCE"l ~j lA~i(i67~-'~
~'"". THI. ""ITI"e,,," IS ,..... .. A MATT'" CO """'MAn""
HRli company of Tampa OlIILY AND CClfllI"EFlS NO RIGHTS UPON THE CERTIFICAte
5405 CYf;'re@s Center Drive ~~~TH~~=I:~':t:f.~~':O~:~lClgT=O:
POBox 2396B ..--
T FL 336 2 3 INSlJREAS AFFClFIDING COVERAGE
tNllUI'IEC INSU~a~ A: Roya. Indemni ty -rn:suranee ompany
;.f~f W;~~:-.~~hr. istian ' INS\i~~R!!:ProgreseTve E:xprsss . - .
Association of Tampa Bay ! 'Nsu~GQn\iral star Indimnity/A(m Risk S
6SS SQClorui Avenue South 1~9U~EI\D:FCCI Insurance COn\pany _.
St. Petersburg, FL 33701 i---,',~--- ~- ~
__ I.. ' It.'8UR.R f.!:
CO'IfEAA13E8
r 'THE F>CUClEt,iOF !NWAAN::E ~,ST'Etl BELOII! /olAV!! BeN ISSUED TC Tr15 INliUFIIC NAMlD MC.'E FCFi rrlE POLICY I"~~TE:D. Ncmvm-t$TANDINGI -
I ANV FlEOOIFll!!MI!NT, T!!P:M OR CONDrTlaII a= ANY CONmCT ~ Oll-'ER OOOU\'lENT wrlH qeSPtC1' TO \/IHIOH TrllO CEA11FICATE MAY ee IS1lUED OR
I MI\Y PERTAIN. TH5 IN8U~ee APPCRlED av 'n,! I"OUOlE8 D~ i-lDlelN is ILBJeCT TO ALL 1111ii 1iIflIo>lt, l()(ClU~IQIIlgMJD CCllJOmONS(J: SUCi-I
PCU01et. I\ClIGiAEQA1T.i WlIlfTli '*'O'WN MoW IolAW BGN RllDUCS) BY P AJi) CUIIMS.
rlN11I - ~... ".u.....~ I ..~.< Ii" i.PO~:C"f."~.cnvli 1.Pt)Liffi'F.iX~IRA ION "uIT8
, H"U'" !~~ M""~ PO~:c;YHl.i"'S " . OloTE 11IM g . Y M'IlD W1 ..,'"
A G;EN511~LlIAIILI~--'< IRSP2 42 23Ei< - .10 I 0 1/0 1 ! 10 Ie 1/02 OJ;CH "CQ\)I'IA~~OF. 1$1. 000,000
X OOMM!~O~lJ!lI!N!!I'lI\,,"I"II~ILliY i Fll'leOAo\IIAG~IAnv,,".fl'.1 1300 000
QLAIM6 I.iAr)~[[J OCOWR I j MEO ,x;;';;'";""pe,aon) ,1'~cCL&OO
- I I I ~!MOIII~Lo\AO\lI~"URl' ~l 000 000
i ~...L: I r';.III~~'~r:;QRi\:jlATIi. ~3~O (. 006-
1~..'N'LAQGREi:iATEL""ITAF'F'c:!!!B"E~: 1 I li"~~OOUC1'S<~!~.?G ~3 <000.,000_
i-I ML Ii fOPO- i~ :
~iE!l.-1 J..C~L I LOD i --'-' I ;-j-.
B i,WTo!o10!li~UIM~I'l'V 1047436120 10/01/01 10/01/02 IG.OMI!IINEOSINGLEIIMI~
I X ANYAUTO 1 I I {!!:n.cI~."I) ,,_
i AI.I.OWN.OAUTOS ! I BOOILYI~NFlV
~ 90H.DU .F.I;lAumS 1 I ~ ~ I
I I~ .IIRI'I)Aurot, i II ~OrDI~::JURY
1 K NON-OWNEOloUT05 I II '!>lIr"'oI~.nil
I I~PI!~lYD4MI\(l1!
I~A~=:~-~.'- - ~.- ~ I ~:~~::~:: EUOOIOSNT ~
i- ANVIoUTO i I :.. OT:iER THA~ E,H!::O m __
. ~ :. AUTOOIolL~ A3G ~
C ~gSLIA-111,ITT ... IItJG3527tieiCO/Ol/Ol. ilO/01l02.1'I!ACHCOC\JI\I'\!",eE--'l$l.OOOJLL.O
I-J OQoul'\ 0 OL...IMS 101" I:IEi I I ...G~REr,;... T~ I'S l_L 0" 0 I 00 Q..
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Dl'.!ClUCnm I I!-f!-
: x RETeNTION $10000 I I. I-~s
D .1: 'NOPKEi'lS eOMPl!'N9I1TIOII 01."'0 '1001WC01A38629 06 724) 0 1106/2 4/02""[!]. X ~~Ql~JHe '
, EMPLOYEIIS' LIA IIILITY !, 10.
h j: i ~'". !IoCHACOIOGNT r!_.~~QL_-
I. Ii!! :"~,CIl8me-=@'EMPI.OYiiiliii $10 0" 000 _.
I 'e' I. 1 H.t1illI!ASE.flOLlCYLIM!T I 000-
AI'''D Profo..io""TjasT348B34 10/01701110/01/021 u, 000,000 ace.
ti~~iltY .. _L, . I 1$3,000,000 ,~99.
I)I!SIMI~TiOH O~ !)/>!l:Il.l. TI!)NllIllOCA'IOII./VIlMllH~lmtOLU.IOhlll A ODIlD .VIlNOOllnMCNtll~;el.ll />I1OVI!lIOlllft
The captioned oertifioata holder is named as lesaor/additiona,l named
insured.
$1,000,000
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CEA
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c~ty of Clearwat8r
612 Fr~nklin Street
Clearwater, FL 33756-5414
'HOULD"N"'OFTHE,,;ovEO"'Q"le~IlI'OLiCI elll.CIo,",C6lLI;O Bl!FORIHHE ElcPIRAT:ON
O"'UlH~"mF"H EIS9UINI!IINSUR Ell WI ~L eN CI!AVOA TO MAII.3lL.. CAVll WFlITrEN
IoiOf1C!TOtHE C!llTI'IOATE HOLO!I\"'''''''~JOTM~ L!P\', RU"IollU~Ero ODSClllHALL
IMl'08ENOOBL:IiA'(ION 011 LIAello11Y OF ANV"'I N0 UPtlN 1M; IN'UFlI'I'R,IYS AG;GNTlI OR
II IEJIII ill iNTAlIVD,
AUTHOllllZ i~ifI~1iS iNT... TIV;
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ACMD 2lI-S (7/91) 1 of 2
#S76l74/M73183
JFN I'll A(''OFlD COfIF"OPIATION 1.
1~JIO/tOl ~:O'IOM
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HI1lHJ:..O..l~IOAN'fO"TA.M"'A.
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IMPORTANT
tf tt1e certificate holder is en ADomONAL INSURED, thll poIlcy(ies) must be endcrsed. A sta\l!lm~nl
en this certlflcate doe!' not confer rights to the eertifioate holder ir'llieu of!tJch endCI'Mment(s).
II' SUBROGATION IS WAWEO, subject to 1I'1e termnnd a:l:d~lons oft1e pollCir, certain policies may
req(Jire an endorsement. ,., statement on this oer'llflcate does n01 ocnflllr rights to the oertl1loete
I'lolder In IIl1iJ of suc:M endorssmsnt(s).
DISCLAIMER
11'10 Certifioate Of lns....rane6 on U'le revart;/uide of 111$ b'm CIOe$ riot OCYl!:tl'J..itft a oontrilct be1ween
1he Issuing lni3Urer(s), authorized representsllve a prcc:kJcer,8I"d the oertlficete tlalder, nor does it
ISffirmalivefv or negatively IJmend, extend 01" alter the OOIIe1'age afforded by the ~lole& li&led thereon.
ACOFID25-817/m2 of 2 #S76174/M73183