CERTIFICATE OF LIABILITY INSURANCE (6)4 May 11 2999 12:39:24
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ACt7RDrM CERTIFICATE OF LIABILITY INSURANCE P4Y3 05-11-2009
AWDLACER 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
224605 P:(866)467-8730 F:(877)538-8526 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
PO BOX 29611 INSURERS AFFORDING COVERAGE
CHARLOTTE NC 28229
wamo INSURER A:Hartford Iris Co of the Southeast
INSURERB:Hartford Underwriters Ins Co
WILLA CARSON HEALTH RESOURCE CENTER INSURER C:
1108 N. MARTIN LUTHER THING JR AVE. INSURER DI
CLEARWATER FL 3 3 755 INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BE HE NSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA
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
enI Irlee AAMIDWIATC I IsAITZ QLJAUMI AAAV I.IAVC ACFNI ACrN ItIPM 14Y PAID CLAIMS-
L?
TYJ?OFlNSldWNCC
POL/CVNL6l0lER
!CY PEC M OL
AGYE FIRAT
PO/fTE LRAMS
GENERAL L/AAKITV EACH OCCURRENCE 91 000 000
A COMMERCIAL GENERAL LIABILITY 21 SBM RQ 7 5 3 2 05/02/09 05/02/10 FIRE DAMAGE IAny one fire) 03 0 D 0 0 0
CLAIMS MADE FRI OCCUR MED EXP (Any one pcson) 410 , 00 0
X Oeneral Liab PERSONAL &AOVINJURY 91 000 000
GENERAL AGGREGATE o2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG 03 0 0 0 0 0 0
POLICY 71 322 X LOC
A AUT G)IIORIE VANYTV
ANY AUTO
21 SBM RQ7532
05/02/09
05/02/10 COMBINED SINGLE LIMIT
(Ea accident) $1,000,000
ALL OWNED AUTOS
SCHEDULED AUTOS BODILY INJURY
(Pc person)
0
X
X HIRED AUTOS
NON-OWNED AUTOS BODILY INJURY
(Per accident)
0
PROPERTY DAMAGE
3
IPc accident) #
GARAGEUAE87TV AUTO ONLY - EA ACCIDENT 0
ANY AUTO OTHER THAN EA ACC 0
AUTO ONLY: AGG 0
EXCESSL4dawy EACH OCCURRENCE S
OCCUR CLAIMS MADE AGGREGATE e
e
DEDUCTIBLE 9
RETENTION 0 0
WORKERS COMPENSATION .410 rte. W C ST T- O T
B EMPLVV$Ra,LLAMITY 21 WEC GC3515 10/03/08 10/03/09 E.L. EACH ACCIDENT x100 000
E.L. DISEASE - EA EMPLOYEE $100,000
E.L. DISEASE - POLICY LIMIT 0,5 0 0 000
AEBQR/PIADIV OP GIPERA77WV6/LOGA 770/YLVVJ:faVLCOYCAf1LHPAV/ytl AvIACV 5rr rnlwnarrmarvuwsvwc rrnrvroNrw
Those usual to the Insured's operations.
MAY . 2 .'009
I City of Clearwater Florida
Attn: Housing Division
112 S OSCEOLA AVE
CLEARWATER,F'L,33756
DULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
yIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
DAYS WRITTEN NOTICE (10 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE
LDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO
LIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS I
rRESENTATIVES.
/NBNRERLETTER.'
ACORD 26-S (7/97) 0 ACORD CORPORATION 1988