CERTIFICATE OF INSURANCE (4)
'--ACORD~
CERTIFICATE OF LIABILITY INSURANCE
OPID A
ALLTE-8 06/03/04
THIS CERTIFICATE IS ISSUED AS A MATTER 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.
DATE IMMIDDIYYYY)
PRODUCER
Rebsamen Insurance Inc(LR)
1500 Riverfront Drive
Little Rock AR 72202
Phone: 501-661-4800 Fax:501-666-9592
INSURED
INSURERS AFFORDING COVERAGE
NAIC #
ALLTEL Wireless
Holdings, LLC
P. O. Box 2177
Little Rock AR 72203-2177
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
Cincinnati Ins Co
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
LTR NSR[ TYPE OF INSURANCE POLICY NUMBER PD~Wjri~rJ~~E P~k~CEYI~~b~~~N LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
-
A X X COMMERCIAL GENERAL LIABILITY COP0686800 01/01/04 01/01/05 PREMISES (Ea occurence) $ 1, OQ9_!OOO
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5,000
PERSONAL & ADV INJUR'( $1,000,000
-
GENERAL AGGREGATE $2,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
I n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $1,000,000
A ~ ANY AUTO COP0686800 01/01/04 01/01/05 (Ea accident)
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
- --
X HIRED AUTOS BODILY INJURY
- $
~ NON-OWNED AUTOS (Per accident)
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
=1' ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $10,000,000
A ~ OCCUR D CLAtMS MADE CCC4428700 01/01/04 01/01/05 AGGREGATE $10,000,000
$
=1 DEDUCTIBLE $
--
RETENTION $ $
WORKERS COMPENSATION AND I TORY LIMITS I IUJ~-
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
----- If yes. describe under -----,-----~ --.--- ____ _______M~_______ - ----- -- ----~ 1------------------- E,L.DISEASE - POLICY LiMIT- ---=-
SPECIAC'PROlllSlOIiISoelow'- $
OTHER
A Prop-Direct Risk CP00686800 01/01/04 01/01/05 Limit 5,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Re: McMullen Booth (FL0182) City's "Del Oro Park Water Tank"
CERTIFICATE HOLDER
CANCELLATION
C I OFC 11 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AU RIZED P ESENTATIVE
@ACORDCORPORATION 1988
City of Clearwater
Attn: Earl Barrett
Real Estate Services Mgr.
P.O. Box 4748
Clearwater FL 33758-4748
ACORD 25 (2001/08)