CERTIFICATE OF INSURANCE
PRODUCER
Marsh USA, Inc.
1166 Avenue of Americas
New York, NY 10036
CERTIFICATE NUMBER
NYC-001273412-02
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
POUCY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR AlTER THE COVERAGE
AFFORDED BY THE POUCIES DESCRIBED HEREIN.
COMPANIES AFFORDING COVERAGE
8882 - TYCO-MACOM-02/03
COMPANY
A AMERICAN HOME ASSURANCE CO
INSURED
M/A COM PRIVATE RADIO SYSTEMS,INC.
3315 OLD FOREST ROAD
LYNCHBURG, VA 24501
COMPANY
B INS CO OF THE STATE OF PA
COMPANY
C Illinois National Ins Co.
COMPANY
D AI SOUTH INSURANCE CO.
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. AGGREGATE
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POUCY NUMBER POUCY EFFECTIVE POUCY EXPIRATION UMITS
LTR DATE (MM/DDIYY) DATE (MM/DDIYY)
GENERAl UABlUTY GENERAL AGGREGATE $ 10,000,000
A X COMMERCIAL GENERAL LIABILITY RMGL 6124879 10/01/02 10/01/03 PRODUCTS - COMP/OP AGG $ 10,000,000
CLAIMS MADE [K] OCCUR PERSONAL & ADV INJURY $ 5,000,000
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 5,000,000
FIRE DAMAGE (Anyone fire) $ 1,000,000
$ 10,000
AUTOMOBILE UABlUTY $ 5,000,000
COMBINED SINGLE LIMIT
A X ANY AUTO RMCA 5348787(TX) 10/01/02 10/01/03
A ALL OWNED AUTOS RMCA 5348788(A1S) 10/01/02 10/01/03 I BODILY INJURY $
A SCHEDULED AUTOS RMCA 5348800(VA) 10/01/02 10/01/03 (Per person)
X HIRED AUTOS BODILY INJURY $
X NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
GARAGE UABlUTY AUTO ONLY. EA ACCIDENT
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
EXCESS UABlUTY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM $
A WORKERS COMPENSATION AND SEE PAGE TWO 10/01/02 10/01/03
EMPLOYERS' UABlUTY
B SEE PAGE.TWQ ,. ottl1f62 . 10/01/03
C THE PROPRIETOR! INCL SEE PAGE TWO 10/01/02 10/01/03
PARTNERS/EXECUTIVE
D OFFICERS ARE: EXCL SEE PAGE TWO 10/01/02 10/01/03
TH
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESlSPECIAL ITEMS
City of Clearwater, as owner is named as additional insured on 91 &lor al with respect to leased radio system site.
City of Clearwater
1900 Grand Avenue
Attn: Rick Carnley
Clearwater, FL 33765
SHOULD At-f'( OF THE POLICIES DESCRIBED HEREIN BE CANCEllED BEFORE THE EXPIRATION DATE THEREOF,
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL ---3.0 DAYS WRITTEN NOTICE TO THE
CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE. ITS AGENTS OR REPRESENTATIVES, OR THE
ISSUER OF THIS CERTIFICATE.
MARSH USA INC.
BY: Katherine S. O'Leary
t~.). IJ);&~
PRODUCER
Marsh USA, Inc.
1166 Avenue of Americas
New York, NY 10036
MIA COM PRIVATE RADIO SYSTEMS,INC.
3315 OLD FOREST ROAD
LYNCHBURG, VA 24501
COMPANY
E NIA
COMPANY
F
COMPANY
G
COMPANY
H
58882 -TYCO-MACOM-02/03
INSURED
WORKERS COMPENSATION POLICIES
10101/02- 10101/03
(A) AMERICAN HOME ASSURANCE
RMWC3322419.
(A) AMERICAN HOME ASSURANCE
RMWC 3322420
(B) INS CO.OF PENNSYLVANIA
RMWC 3322421
(C) ILLINOIS NATIONAL INS.CO.
RMWC 3322422
(C) ILLINOIS NATIONAL INS. CO.
RMWC3322423
(D) AI SOUTH INSURANCE CO.
RMWC3322424
(A) AMERICAN HOME ASSURANCE CO.
RMWC3322425
STATE
CA
NV,OR
AR,FL,MA,TN,VA
IL,LA
NY,WI
GA
ALL OTHER STATES