CERTIFICATE OF INSURANCE - #30768
PRODUCER
J&H Marsh & McLennan,
191 Peachtree Street,
Suite 3400
Atlanta, GA 30303
Inc.
N.E.
THIS CERTIFICATE IS ISSUED AS A MATIER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN
THE POLIcY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY TIlE POLICIES LISTED HEREIN.
BELLSOUTH CORPORATION INCL.
BELLSOUTH MOBILITY INC
ROOM 15A01
1155 PEACHTREE STREET, NE
ATLANTA, GA 30309-3610
COMPANIES AFFORDING COVERAGE
COMPANY A HARTFORD FIRE INSURANCE CO
LETTER
COMPANY B HARTFORD CASUALTY INS CO
LETTER
COMPANY C
LETTER
COMPANY D
LETTER
INSURED
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED,
NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY
BE ISSUED OR_MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES LISTED HEREIN IS SUBJECT TO ALL THE TERMS. CONDITIONS AND EXCLUSIONS
OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
POUCY EFFECTIVE
DATE (MM/DD/YY)
10/15/97
TYPE OF INSURANCE
POlICY NUMBER
POlICY EXPIRATION
DATE (MM/DD/YY)
10/15/98
UMITS
20 CSE J42031
20CSEJ42032
GENERAL AGGREGATE $
PRODUCTS-COMP lOP AGG $
PERSONAL & ADV INJURY $
EACH OCCURRENCE $
FIRE DAMAGE (Anyone/ire) $
MED. EXPENSE (Anyone person) $
3000000
1000000
1000000
1000000
1000000
COMMERCIAL GENERAL LIABILITY
D CLAIMS MADE~OCCUR.
OWNER'S CONTRACTOR'S PROTo
10000
COMBINED SINGLE LIMIT
$
$
2000000
X ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
BODILY INJURY (Per person)
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
GARAGE UABIUTY
20WNJ42030
AUTO ONLY - EA ACCIDENT $
OTHER THAN AUTO ONLY
EACH ACCIDENT $
AGGREGATE $
EACH OCCURRENCE $
AGGREGATE $
10/15/97 10/15/98 STATUTORY LIMITS X
EACH ACCIDENT $ 1000000
DISEASE - POLICY LIMIT $ 1000000
DISEASE - EACH EMPLOYEE $ 1000000
ANY AUTO
EXCESS UABIUTY
UMBREUA FORM
OTHER THAN UMBREUA FORM
WORKERS' COMPENSATION AND
EMPLOYERS UABI./TY
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
(SEE REVERSE AND/OR ATTACHED)
CERTIFICATE HOLDER
CITY OF CLEARWATER
ATTN: FRED BELZEL-CITY MGR.
P.O. BOX 4748
CLEARWATER, FL 33758-4748
CANCELLATION
SHOULD ANY OF THE POLICIES LISTED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE
THEREOF. THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED HEREIN. BUT FAILURE TO MAIL SUCH NOTICE
SHALL POSE 0 OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER AFFORDING
COV G. IT AGE OR RE SENT TIV"Es. OR THE ISSUER OF THIS CERTIFICATE.
& NN RPO
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DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
INSURED
HOLDER
CERTIFICATE #30768
BELLSOUTH CORPORATION INCL.
CITY OF CLEARWATER
ATTN: FRED BELZEL-CITY MGR.
P.O. BOX 4748
CLEARWATER, FL 33758-4748
(CONTINUED)
ADW
RE: SITE ADDRESS - 440-062.1
CITY OF CLEARWATER
3290 S.R. 580 @ McMULLEN BOOTH ROAD
PINELLAS COUNTY, FL
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