CERTIFICATE OF LIABILITY INSURANCE (5)
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Rebsamen Insurence/LRK
1500 Riverfront Drive
P. O. Box 3198
Little Rock, AR 72203-3198
(5011 661-4829
INSURED
12/04/00
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
COMPANY
A
Cincinnati Insurance Com any
ALLTEL Wireless Holdin9s, LLC
d/b/a ALLTEL Corporation
P. O. Box 2177
Little Rock, AR 72203-2177
COMPANY
B
COMPANY
C
COMPANY
THIS IS TO CERTIFY THA TTHE POLICIES OF INSURANCE LISTED BELOW HA VE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICA TED,NOTWITHST ANDING ANY REQUIREMENT, TERMOR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICHTHIS
CERTIFICA TE MA Y BE ISSUED OR MA Y PERT AIN, 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.
.. -TYPE OF INSURANCE POLlCTNUMBER-. POJ.lCY_EfFE~TI"'~PQLI!::'LEXPIRATI_()1\I
DATE (MM/DD/YY) DATE (MM/DD/YY)
-. LIMITS
LTR
A GENERAL LIABILITY COPo68680o 1101101 1101102 GENERAL AGGREGATE $
COMMERCIAL .GENERAL LIABILITY PRODUCTS.COMP/OP A.GG $ 2,000,000
CLAIMS MADE W OCCUR PERSONAL & ADV INJURY $ 1,000,000
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000
X Contractual FIRE DAMAGE (Anyone tire) $ 1,000.000
MED EXP (Anyone person) $ 5.000
A AUTOMOBILE LIABILITY COP06868oo 1101101 1101102
COMBINED SINGLE LIMIT $
X ANY AUTO 1,000,000
ALL OWNED AUTOS BODIL Y INJURY $
SCHEDULED AUTOS (Per person)
X HIRED AUTOS BODILY INJURY $
X NON.OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
A EXCESS LIABLITY CCC44287000 1101101 1/01/02 EACH OCCURRENCE $ 5,000,000
X UMBRELLA FORM AGGREGA TE $ 5,000,000
OTHER THAN UMBRELLA FORM $
A WORKERS COMPENSATION AND WCC19092ooo 1101101 1101102
EMPLOYERS' LIABILITY $
100,000
THE PROPRIETORI INCL EL DISEASE.POLlCY LIMIT $
P ARTNERS/EXECUTI VE 500,000
OFFICERS ARE: EXCL EL DISEASE.EA EMPLOYEE $ 100,000
OTHER
A Commercial Property COP06868oo 1/01/01 1101102 All Risk Replacement Value
Coverage Including EDP
DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/SPECIAL ITEMS
Re: McMullen Booth (FL0182) City's "Del Oro Park later Tank." Certificate Holder Is Included as Additional Insured ATIMA.
....................................................................
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City of Clearwater
Attn: Eerl Barrett,
Real Estate Services Menage
P. 0, Box 4748
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I ! i! EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
DEe I I 2000 3D DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
t BUT FAILURE TO MAL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS .OR REPRESENTATIVES.
AUTHORIZED R ESENTATIVE
CITY OF ClUF"..; r >,
PUBLIC WORKS Ar'" '.:" '~'.~_
D. Howard
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CERTIFICATE: 003/001/ 00656