CERTIFICATE OF INSURANCE POLICY NUMBER O2CC5465645
........AC6Rji.::i5:l5m,.I.<.&iIISAT;I...........;:~r.HI@I<:il;WJ:I'i{l~tli'OII'Y DATE(MMIDDIYY)
(:t............................. ?!'~.fi~.~..E'..~!tl!:.... ...:......I1:.~..mEr:.:.,.;:.....:.,:.,.\.:~l!.e~:....}........:.:' 01/26/1999
PRODUCER (727)736-2505 FAX (72 733-5161 THIS CERnFICATE IS .:DASAMATTEROFINFORMATION
All & A I ' ONLY AND CONfERS NO GHTS UPON THE CERTIFICATE
m." en S50(:, nc. HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
811 Douglas Ave. ALTERTHECOVERAGEAFFORDEDBYTHEPOUCIESBELOW.
P.O. Box 1138 COMPANIES AFFORDING COVERAGE
Dunedin, FL 34698 COMPANYuAiiiericanEconomyU
~: ~ A
INSURED 1 .. 1 COMPANY
C earwater Hlstorlca B
Sod ety
P. O. Box 175
Clearwater, FL 33757-0175
COMPANY
C
COMPANY
D
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOlWlTHSTANDlNG ANY REQUIREMENT, TERMOR CONDITION OF /WY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PE:RTAlN, THE INSURANCE AfFORDED BY THE POlICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDmONS OF. SUCH POLICIES, LIMITS .SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MMlDDIYY) DATE (MMIDDIYY)
LIMITS
FIRE DAMAGE (Anyone fire)
MED EXP (Anyone person)
U u~ ()() 'u()()()
500,000
uu50(),()()()
50(),0()0
200,000
10 000
. GENERAL LIABILITY
X : COMMERCIAL GENERAl LIABILITY .
A ... CLAIMS MADE X OCCUR 02CC5465645
. OWNER'S & CONTRACTOR'S PROT .
01/20/1999 01/20/2000
GENERAL AGGREGATE $
PRODUCTS - COMPIOP AGG $
$
$
$
$
PERSONAL & ADV INJURY
EACH OCCURRENCE
. AUTOMOBILE LIABILITY
: ANY AUTO
: ALL OWNED AlJTOS
. SCHEDULED AlJTOS
HIRED AlJTOS
. NON-OWNED AlJTOS
COMBINED SINGLE LIMIT
$
BODILY INJURY
(per person)
$
BODILY INJURY
(per accident)
$
PROPERTY DAMAGE $
GARAGE LIABILITY
ANYAlJTO
AlJTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EACH $
$
. EXCESS LIABILITY
. UMBRElLA FORM
. OTHER THAN UMBRELLA FORM
. WORKERS COMPENSATION AND
. EMPLOYERS' LIABILITY
EACH OCCURRENCE
AGGREGATE
$
_~.._THEJ'RQI"R--IETQRI .._..
PARTNERSJEXECUTIVE
.. OFRCERSARE:--
OTHER
. ItlCL .
-: EXCL'
TORY LIMITS.
EL EACH ACCIDENT
DESCRIPTION OF OPERATIONSILOCATIONSIVEH~IAL ITEMS
ocation: 1350 S. Greenwood Avenue, Clearwater, FL
ity Of Clearwater Is Named As Additional Insured
City Of Clearwater
Att: Debra Richter
Administrative Support, Manager 1
P. O. Box 4748
Clearwater, FL 34618
SHOULD ANY OF THE N!OVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIFICA
BUT FAILURE TO L SUCH NOTICE HALL 1M