CERTIFICATE OF INSURANCE (236)
A COROTM
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIVYI
12/23/03
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.
PRODUCER
ACaRDIA EAST - TAMPA BAY
P.O. Box 31666
Tampa, FL 33631-3666
727-796-6666
INSURERS AFFORDING COVERAGE
INSURED
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
HARTFORD INSURANCE GROUP
Image One
Image One Corp dba
6206 Benjamin Rd #301
Tampa FL 33634
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,
I~~: TYPE OF INSURANCE POLICY NUMBER ~9..~p EFFECTIVE P8k!fEY,~~m~JJ~~ LIMITS
A GENERAL LIABILITY 21SBALl1614 1/01/04 1/01/05 EACH OCCURRENCE $ 1000000
-
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ 300000
I CLAIMS MADE W OCCUR M ED EXP (Anyone person) $ 10000
PERSONAL & ADV INJURY $ 1000000
GENERAL AGGREGATE $ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG $ 2000000
I n PRO- nLOC
POLICY JECT
A AUTOMOBILE LIABILITY 21 UECLl4905 1/01/04 1/01/05 COMBINED SINGLE LIMIT
~ (Ea accident) $ 1000000
~ ANY AUTO
ALL OWNED AUTOS BODILY INJURY
f-- (Per person) $
SCHEDULED AUTOS
f--
L HIRED AUTOS BODILY INJURY
(Per accidentl $
L NON-OWNED AUTOS
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A EXCESS LIABILITY 21SBALl1614 1/01/04 1/01/05 EACH OCCURRENCE $ 1000000
o OCCUR D CLAIMS MADE AGGREGATE $ 1000000
$
R DEDUCTIBLE 10000 $
RETENTION $ $
7\ WORkERS.COI\llPEN'SA TIONAND - ,-- 21WECI3U9811-~--~<--- 1-/01/04 - .. j ICULOS I T":;~J;~T.~;, I IOJ~-
EMPLOYERS' LIABILITY E,L. EACH ACCIDENT $
1000000
E,L. DISEASE - EA EMPLOYEE $ 1000000
E,L. DISEASE - POLICY LIMIT $ 1000000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS J<t:l; E: I V I: U
CERTIFICATE HOLDER IS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY
DEe 23 2003
OFFICIAl RECORDS AND
. ~_._. .-..
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION .. ...";Y.....,, 1Jr::I""
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF CLEARWATER DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ---1.Q.. DAYS WRITTEN
A TT: CITY CLERK NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
POBOX 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
CLEARWATER FL 337584748 REPRESENTMfJVES, /'J
AUTH~ ~PR:r;~~/
I
ACORD 25-S (7/97) 45- 38 ~ l/ V "7 @ACORD CORPORATION 1988