CERTIFICATE OF INSURANCE (3)
............ ..... ...... ........ . .... ...... ... ......... ..... ................... ......................................
A COf!g~........:....III.I~:I~llml..............II. .....~~_I'~':I.:.:::;. .1:1.111.111.1.........................................................DA1~/~:~~O:lYy).... ..
.~~6bO(i~~ THIS CERTIFICATE IS ISSUED AS A MAHER OF INFORMATION
ONL Y 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
Rebsamen Insurance/LRK
1500 Riverfront Drive
P. O. Box 3198
Little Rock, AR
(5011 661-4800
INSURED
72203-3198
COMPANY
A
Cincinnati Insuranca Company
ALLTEL Wiraless Holdings,
dlbla ALLTEL Corporation
P. O. Box 2117
Little Rock, AR 72203
LLC
COMPANY
B
COMPANY
C
THIS IS TO CERTIFY THA T THE 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 OTHERDOCUMENTWITHRESPECT TO WHICH THIS
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 POLICY NUMBER P:;~~~:~~~~~~ P~~~:(~~:~~i~~~ LIMITS
A GENERAL LIABILITY
X CDMMERCIAL GENERAL LIABILITY
CLAIMS MADE c:!l OCCUR
DWNER'S & CDNTRACTOR'S PROT
COP0686800-02
1101104
1/01/1)!!
GENERAL AGGREGATE
2,CDC,OQC
2,000,000
1,000,000
1,000,000
1,000,000
5,000
$
$
PERSONAL & ADV INJURY $
$
$
$
PRDDUCTS.CDMP/DP AGG
EACH DCCURRENCE
FIRE DAMAGE (Anyone fire)
MED EXP (Anyone person)
A AUTOMOBILE LIABILITY
X ANY AUTO
ALL DWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NDN.OWNED AUTDS
COP0686800-02
1101104
1101105
COMBINED SINGLE LIMIT $
1,000,000
BODIL Y INJURY
(Per person)
$
BDDIL Y INJURY
(Per accident)
PROPERTY DAMAGE
A EXCESS LIABILITY
X UMBRELLA FDRM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
JJ:IE_-I'S0.PRIEJQB/__..__
PARTNERS/EXECUTI VE
DFFICERS ARE:
CCC4428700
1101104
1101105
AUTO. DNL Y . EA ACCIDENT
OTHER THAN AUTO DNL Y:
EACH ACCIDENT
AGGREGA TE
EACH OCCURRENCE
AGGREGA TE
10,000,000
10,000,000
GARAGE LIABILITY
ANY AUTO.
EXCL
$
LIMIT $
$
-INCC
OTHER
A Commercial Package
COP0686800-02
1101104
1/01105
Direct Risk - Property
DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/SPECIAL ITEMS
Re: McMullen Booth (FL0182) City's "Del Oro Park Water Tank." Certificate Holder is included as Additional Insured ATIMA.
(DlZ-\~ ~ C::l~ ~L~I2f(:
City of Clearwater
Attn: Ear I Barrett ' . r......
Rea I Estate Serv ices MgrJ l.i ~ q.. -: ,5 :(1(1'
P. O. Box 4748 L ' .
Claarwter, FL 33758-474 61i-orw~:~ -.'-T"[;i-J. I
....... ..J .......l_.~tlBLlC WORKS ADMJNiSTf:ATIGN
.A.Q08D.2$..$ 11.$$..?::==?= .,.((===:=:=::::/}= .... ............... .,..
EXPIRATION DATE, THEREOF,. T!;I,E.I$lilJ!!'lQ"C.QMPANY WIll. ENDEAVOR TO MAIL
30 DAYlflollRlrieN NOf,ICETO THE~Eft~I~ICATEHOLDER N~~ THE LEFT,
BUT FAILUR,~ TO MAIL, SUC. H NOTICE SHAll. IMPOSE NO OBLIGATION 9,!k,LIABILITY
OF ANY KIND UPC),N-THE CO Y, ITS AGENTS OR REPRE~TATIVES.
AUTHORIZED REPRES
'.
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CERTIFICATE: 006/0011 0065
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