CERTIFICATE OF LIABILITY INSURANCE (5)Io!a rPP `a' RAW
ACORD
CERTIFICATE OF LIABILITY INSURANCE DATE
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PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
BROWN & BROWN OF FLORIDA INC/PHS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
605 P:(866)467-8730 F:(877)538-8526 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
BOX 29611
0
CHARLOTTE NC 2 8 2 2 9 INSURERS AFFORDING COVERAGE
INSURED -INSURER A:Hartford Ins Co of the Southeast
INSURER B: Hartford Underwriters Ins Co
WILLA CARSON HEALTH RESOURCE CENTER INSURER C:
1108 N. MARTIN LUTHER KING JR AVE. INSURER D:
CLEARWATER FL 3 3 7 5 5 INSURER E:
COVERAGES
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 D OCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HE REIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR rypE OF INSURANCE POLICY NUMBER
N
S
LTR POLICY EFFECTIVE POLICY EXPIRATION LIMITS
DATE MM/DD/YY DATE MM/DD/YY
GENERAL LIABILITY EACH OCCURRENCE $1, 000, 000
A COMMERCIAL GENERAL LIABILITY 21 SBM RQ 7 5 3 2 05/02/08 05/02/09 FIRE DAMAGE (Any one fire) s300, 000
_ , - CLAIMS MADE X I OCCUR I
MED EXP (Any one person) $10, 000
X General Liab PERSONAL & ADV INJURY $1 , 0 0 0 , 0 0 0
GENERAL AGGREGATE s2, 000, 000
GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2, 000, 000
POLICY PRO X LOC
JECT
AUT OMOBILE LIABILITY
COMBINED SINGLE LIMIT
1
000
000
id
t)
(E ,
$
,
A ANY AUTO 21 SBM RQ7532 05/02/08 05/02/09 a acc
en
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS
(Per person) $
X HIRED AUTOS
BODILY INJURY
X
NON-OWNED AUTOS
(Per accident) $
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: qGG $
EXCESS LIABILITY j EACH OCCURRENCE $
OCCUR a CLAIMS MADE AGGREGATE $
$
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X WC STATU- OTH-
ER
B EMPLOYERS' LIABILITY 21 WEC GC3 515 10/03/08 10/03/09 E.L. EACH ACCIDENT $100, 000
.. ---'-. --...- _ - -. - - _.- - - - E.L. DISEASE --EA-EMPLOYEE $100,000
E.L. DISEASE - POLICY LIMIT $500,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ?0?
2
Those usual to the Insured's Operation s.
L
CERTIFICATE HOLDER i I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
y of Clearwater Florida EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE (10 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE
*n: Housing Division
112 S OSCEOLA AVE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO
OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
CLEARWATER
FL
33756
,
, A ORI R ESEN ATIYE?
ACORD 25-S (7/97) ® ACORD CORPORATION 1988