CERTIFICATE OF LIABILITY INSURANCE
ACORD..
CERTIFICAT
OF LIABILITY INSUR
C~PID 71
GAYLO-1 04/06/99
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.
DATE (MMIDDIYY)
..
PRODUCER
The Young Agency, Inc.
500 Plum street, Ste. 200
Syracuse NY 13204
Phone:315-474-3374 Fax:315-474-7039
INSURED
INSURERS AFFORDING COVERAGE
Gaylord Brothers
7272 Morgan Road
P.O. Box 4901
Syracuse NY 13221
COVERAGES
INSURER A: American Mfgs Mutual Ins CO
INSURER B: Na tional Union Fire Ins CO.
INSURER c: American Protection Ins. CO.
INSURER D:
INSURER E:
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.
lI~ft TYPE OF INSURANCE POLICY NUMBER 5~flf7MX~SI1~ E P~~j.~! EX~~;JWN - UMITS- ...--
AI 'MMlDD ._-,-- -
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
r--
A X COMMERCIAL GENERAL LIABILITY 3ML10318202 12/31/98 12/31/99 FIRE DAMAGE (Anyone fire) $ 500,000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 10,000
~ ADDT. INSURED * PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
I n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
-
A X ANY AUTO 3ML10318202 12/31/98 12/31/99 (Ea accident)
-
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AUTOS
-
~ HIRED AUTOS BODILY INJURY
(Per accident) $
X NON-OWNED AUTOS
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $ 10,000,000
A ~ OCCUR D CLAIMS MADE 3SX04957500 12/31/98 12/31/99 AGGREGATE $ 10,000,000
$
r=l DEDUCTIBLE $
X RETENTION $ 10 000 $
_ WORKERS COMPENSATION AND I TORY L1MrrS I IUJ~-
C EMPLOYERS' LIABILITY 3BR01108702 12/31/98 12/31/99 EL. EACH ACCIDENT $ 500,000
EL. DISEASE - EA EMPLOYEE $ 500,000
EL. DISEASE - POLICY LIMIT $ 500,000
OTHER
B EDP E&O COVERAGE 8615660 05/06/98 05/06/99 OCC $3,000,000
AGG $3,000,000
DESCRIPTION OF OPERATIONS/LOCATlONSNEHICLESJEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
THE CITY OF CLEARWATER,ITS OFFICERS,EMPLOYEES & VOLUNTEERS ARE ADDED AS
ADDITIONAL INSUREDS WITH RESPECT TO BUSINESS PERFORMED WITH GAYLORD
BROTHERS. COVERAGE IS PRIMARY.
CERTIFICATE HOLDER I Y I ADDmONAL INSURED; INSURER LETrER: CANCELLATION
CLEARXX SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
CITY OF CLEARWATER -
100 NORTH OSCEOLA AVENUE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF
CLEARWATER FL 34615 ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
I ~. ~~Cj. ~ A~'-L-,
'1-(. . , -, ,
ACORD 25-S (7/97) (/ / .. ACORD CO'RPORATION 1988
.I"
I
I
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25-8 (7/97)