CERTIFICATE OF INSURANCE (14)
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MARSH USA INC. '"i' CERTIFICATE OFI'ISURANCE CERTIFICATE NUMBER
NYC-001133201-02
PRODUCER THIS CERTIFICATE IS ISSUED At, ). MATTER OF INFORMATION ONLY AND CONFERS
MARSH USA INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
1166 AVENUE OF THE AMERICAS, 40TH FLOOR POLICY, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
NEW YORK, NY 10036-2774 AFFORDED BY THE POLICIES DESCRIBED HEREIN,
TEL: 212-345-3259 COMPANIES AFFORDING COVERAGE
FAX: 212-345-4725/4268
ATTN: VIVIAN EDWARDS COMPANY
b1042 -GTE-all-01-02 MOBIL TX VA FL A ZURICH AMERICAN INS.CO
INSURED COMPANY
"GTE MOBILNET OF TEXAS B N/A
DBA VERIZON WIRELESS
ATTN: PAM ANDREWS COMPANY
300 MCLAWS CIRCLE, STE 201 C
WILLIAMSBURG, VA 23185-5648
COMPANY
D
COVERAGES This certificate supersedes and replaces any previously issued certificate for the policy period noted below. 1
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED 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 DESCRIBED HEREIN IS SUBJECT TO AlL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES, LIMITS SHOWN
MAY HAVE BEEN REDUCED BY PAID CLAIMS,
co TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE IMM/DDIYY) DATE (MMIDDIYY)
JL_ Jl~E~~!:!.ABllI!y___~_____ ~?984372-00 06/30/02 06/30/03 r.I"NI"IUI TI" $ 2,000,000
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X COMMERCIAL GENERAL LIABILITY PRODUCTS-COM~OPAGG $ INCLUDED
I I CLAIMS MADE 0 OCCUR PERSONAL & ADV INJURY $ 2,000,000
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 2,000,000
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FIRE DAMAGE (Anyone fire) $ 50,000
MED EXP {Anyone DefSOnI $ 10,000
AUTOMOBILE LIABILITY $
r-- COMBINED SINGLE LIMIT
f-- ANY AUTO
r-- AlL OWNED AUTOS BODILY INJURY $
(Per person)
- SCHEDULED AUTOS
- HIRED AUTOS BOOIL Y INJURY $
(Per lICddenl)
f-- NON-OWNED AUTOS
PROPERTY DAMAGE $
GARAGE L1AB1UTY AUTO ONLY- EA ACCIDENT $
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~ ANY AUTO OTHER THAN AUTO ONLY: "
. EACH ACCIDENT $
AGGREGATE $
EXCESS UABlUTY EACH OCCURRENCE $
R UMBRELlA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM $
WORKERS COMPENSATION AND I TORY LIMITS I IUE~' .:'..
EMPLOYERS' LIABILITY .,
EL EACH ACCIDENT $
. THE PROPRIETOR! R:NCL ~..... - '--- - .-...- ~.._- - - T- -. - - .----
EL DISEASE-POLICY LIMIT
PARTNERSlEXECUTIVE EL OISEASE-EACH EMPLOYEE $
OFFICERS ARE: EXCL
IOTHIOR
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESISPECIAlITEMS ILlMITS MAY BE SUBJECT TO DEDUCTlBLES OR RETENTIONS)
RE: COUNTRYSIDE CELL SITE,
CERTIFICATE HOLDER IS ADDITIONAL INSURED (EXCEPT ON WORK COMP) AS RESPECTS OPERATIONS OF THE NAMED INSURED TO THE
EXTENT AND LIMITS REQUIRED BY CONTRACT.
CERTIFICATE HOLDER CANCELLATION
J ,"" ~ , .
SHOULD IlH'f Of' 1llE POUCIES DESCRI8EO HEREIN BE CANCElLED BEFORE THE EXP.....TIDH DA~ THEREOF,
THE ~ AFFORDING COIIERAGE WLI. ENDEAVOR TO MAIL ----3.Q DAYS WRmEN N011CE TO THE
CITY OF CLEARWATER CERTFICA~ HOlDER _0 HEREIN, BUT FAILURE 10 MAL SUCH NOnCE SHAll ..osE NO DBLIGATlDN OR
P.O. BOX 4748
CLEARWATER, FL 34618-4748 UAlIIl.ITY Of' IlH'f KINO UPON THE INSURER AFFORDING COVERAGE, ns AGENTS OR REPRESENTAT1VE$,
ATTN: CITY MANAGER
MARSH USA INC. JIlbt"-- b......
BY: Steven Becker
" ',.,". ....... 11111(8198) -- "~-V. '., ,-, .YAUD AS OF: 06l26I02 -
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