CERTIFICATE OF INSURANCE (8)
ACORDTM CERTIFICA Tt= OF LIABILITY INSURANCE I DATE (MMlDDIYYYY)
07/14/2004
PRODUCER (727) 789-1488 THIS CERTIFICATE IS ISSUED AS A MA TIER OF INFORMATION
Long & Company Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
29190 U S Hwy 19 N ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
POBox 14958
Clearwater FL 33766-4958 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: COLONY INSURANCE CO
TAMPA BAY COMMUNITY DEVELOPMENT CORP INSURER B:
INSURER C:
2139 NE COACHMAN RD INSURER D:
CLEARWATER FL 33758- 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 DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
fNSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION
LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MMlDDIYV) DATE (MWDDIYV) LIMITS
A GENERAL LIABILITY GL3161344 02/25/2004 02/25/2005 EACH OCCURRENCE $ 1,000,000
- ~~~~%J?E~~~nce\ 50,000
X COMMERCIAL GENERAL LIABILITY $
I CLAIMS M1ADE ~ OCCUR / / / / MED EXP (Any one person) $
PERSONAL & ADV INJURY $ 1,000,000
- , / / / / l,OOOrOOO
GENERAL AGGREGATE $
- l,OOOrOOO
n'L AGG~nE LIMIT nES PER: PRODUCTS - COMP/OP AGG $
PRO- / / / /
POLICY JECT LOC
~TOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT
(Ea accident) $
ANY AUTO
- / / / /
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AUTOS
- / / / /
HIRED AUTOS BODILY INJURY
- (Per accidant) $
I-- NON-OWNED AUTOS
/ / / / PROPERTY DAMAGE
I-- (Per accident) $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
:=j ANY AUTO / / / / OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSlUMBRELLA LIABILITY / / / / EACH OCCURRENCE $
t=I OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE / / / / $
RETENTION $ $
WORKERS COMPENSATION AND / / / / I T~,STATU- I 10TH-
TO Y LIMITS ER
EMPLOYERS' UABILlTY
ANY PROPRIETOR!PARTNERlEXECUTIVE E.L EACH ACCIDENT $
OFFICERlMEMBER EXCLUDED? / / / / E.L DISEASE - EA EMPLOYEE $
If yas, dascribe undar E.L DISEASE. POLICY LIMIT $
SPECIAL PROVISIONS balow
OTHER / / / /
/ / / /
/ / / /
DESCRIPTION OF OPERA TlONSlLOCA TlONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
DEVELOPMENT OF ~SmEN'l'J:AL PROPERTY
CERTIFICATE HOLDER
( )
CITY OF CLEARWATER
POBOX 4748
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTI TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
o SHALL JOSE NO OBLIGATION OR UABILlTY OF ANY KIND UPON THE
CLEARWATER
.CORD 25 (2001/08)
~.......INS025 (01DB).D5
FL 33758-
@ ACORD CORPORATION 1988
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ELECTRONIC LASER FORMS, INC. - (BDO)327-ll545
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