CERTIFICATE OF INSURANCE (5)
~~ACORD_ CERTIFICATE OF LIABILITY INSURANCE OP 10 8~ DATE (MM/DDIYYYY)
ALLTE-8 12/17/04
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Rebsamen Insurance Inc(LR) HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
1500 Riverfront Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Little Rock AR 72202
Phone: 501-661-4800 Fax:501-666-9592 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A; Cincinnati Ins CO
INSURER B: Liberty Insurance Corp.
ALLTEL Wireless Holdings, LLC INSURER C: *Ml\RSH USA IS BROKER OF RECORD
P. O. Box 2177 INSURER D:
Little Rock AR 72203-2177
INSURER E:
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 \/IiHICH 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 DATE IMM/DDIYY DATE MM/DOiYYI LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
f---
A X COMMERCIAL GENERAL LIABILITY COP0686800 01/01/05 01/01/06 PREMISES lEa occurencel $ 1,000,000
f- j CLAIMS MADE ~ OCCUR $ 5,000
MED EXP (Anyone person)
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2 , 000,000
GEN'L AGG~EnE LIMIT APPLIES PER: PRODUCTS-COM~OPAGG $ 2,000,000
!xl PRO- n
X POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
-
A X ANY AUTO COP0686800 01/01/05 01/01/06 (Ea accident)
-
ALL OWNED AUTOS INCLUDES GARAGE LIABILITY BODILY INJURY
- (Par person) $
SCHEDULED AUTOS
-
X HIRED AUTOS BODILY INJURY
- (Per accident) $
~ NON-OWNED AUTOS
. PROPERTY DAMAGE
- (Per eccident) $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
=1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSlUMBRELLA LIABILITY EACH OCCURRENCE $10,000,000
A ~ OCCUR o CLAIMS MADE CCC4428700 01/01/05 01/01/06 AGGREGATE $ 10,000,000
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X I TORY LIMITS I I OJ~-
B EMPLOYERS' LIABILITY WA7-64D-005098-015 01/01/05 01/01/06 E.L. EACH ACCIDENT $ 500,000
ANY PROPRIETORIPARTNERlEXECUTIVE
B OFFICERlMEMBER EXCLUDED? WC7-641-005098-025 01/01/05 01/01/06 E.L. DISEASE - EA EMPLOYEE $ 500,000
- ~~EM.tS~Wov'ffi~o~s below _.---- .- ----,-- -.. - --- -.-. " ._.~- -- -~_.. . ....__......._f- ---- ------" .-----._---- eT DISEASE - POLICY LIMIT '$500,00'0
OTHER
A Prop-Direct Risk CP00686800 01/01/05 01/01/06 Limi t : $5,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
RE: McMullen Booth (F10182) City's "Del Oro Park Water Tank". Certificate
Holder is included as Additional Insured ATIMA.
CERTIFICATE HOLDER
CANCELLATION
COOFCL2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
Real Estate Services Mqr. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Attn: Earl Barrett IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O. Box 4748
Clearwater, FL 33758-4748 REPRESENTATIVES.
A EPR~ENTATlVE
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ACORD 25 (2~01/08)
@ACORDCORPORATION 1988