CERTFICATE OF INSURANCE
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City of Clearwater
Interdepartment Correspondence Sheet
TO:
Susan Stephenson, Documents & Records Supervisor
Earl Barrett, Real Estate Services Manager ~
Kimberly Home, Inc. certificate of insurance
R,ECEI'TED
AUG 2 () 1996
FROM:
SUBJECT:
DATE:
August 19, 1996
CITY CLERK DEPT.,
Attached hereto for official City records is the original Certificate of Insurance I received
from Kate Kelly at The Kimberly Home listing the City as additional insured under its
business insurance policy with National Union Fire Insurance. The certificate is provided
in compliance with requirements of a License Agreement For Vehicular Parking the City
granted on July 26,1996,
Please give me a call if there are any questions,
~
PROOUCER
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
The Eagle Companies
4115 Annandale Road
Suite 203
Annandale, VA
22003
COMPANIES AFFORDING COVERAGE
COMPANY A
LETTER
National Union Fire Ins.
COMPANY B
LETTER
The Kimberly Home, Inc.
1189 N .E. Cleveland St.
Clearwater, FL
34615
COMPANY C
LETTER
COMPANY 0
LETTER
COMPANY E
LETTER
THIS IS TO CERTIFY THAT 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 RESPECTTOJNHJCtiJHIS
CERT1FICJITElIJIIWBElSSUED ORlVI1Wl'ERTAIN, I HI: II'JSlJtWJCEAFFORDED'BVTHEPOlTCTNUEscmRERE1NlS SUBJrCTTOALL THE TERMS, .
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DDIYY) DATE (MM/DDIYY)
LI MilS
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
A HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION
AND
EMPLOYERS' LIABILITY
OTHER
A Prof. Liability
COMBINED SINGLE
LIMIT
1,090,000 H .
1,000,000
H.1.~000,OOO....
1 ~OOO,OOO
..50,090..
2,000
1,000,000
A
. OCCUR.
MLP208310B
05/01/96
01/01/97
GENERAL AGGREGATE
PRODUCTS.COMP/OP AGGR.
PERSONAL & ADV. INJURY
EACH OCCURRENCE
FIRE DAMAGE (Anyone fire)
MED. EXPENSE (Anyone person)
GENERAL LIABILITY
BODILY INJURY
(Per person)
MLP20B3108
05/01/96
01/01/97
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
EACH OCCURENCE
AGGREGATE
EACH ACCIDENT
DISEASE-POLICY LI MIT
DISEASE.EACH EMPLOYEE
MLP20B3108
05/01/96
01/01/97
Gen, Aggr.
Per Occur.
1,000,000
1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
Property/Contents #MLP20831 08 Effective 5/1/96 to 1/1/97 Limit $25,000
Building Coverage $125,000 Effective 5/1/96 to 1/1/97
Additional insured: City of Clearwater
NON188
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City of Clearwater
P.O. Box 4748
Clearwater, FL
34618-4748
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHO~tZED REPRESENTATIV~ l, ' ",' Q
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