CERTIFICATE OF INSURANCE (252)
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYY)
1 211 0/04
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Acordia Southeast, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 31666 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tampa, FL 33631-3666
727-796-6666 INSURERS AFFORDING COVERAGE
INSURED INSURER A: HARTFORD INSURANCE GROUP
Image One
Image One Corp dba INSURER B:
6206 BenJamin Rd #301 INSURER c:
INSURER D:
!ampa FL 33634
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.
INSR TYPE OF INSURANCE POLICY NUMBER ~9.';!~rJ~~5'6~~ P8J;!.fEY EXPIRATION LIMITS
LTR
A ~ERAL LIABILITY 21SBALl1614 1/01/05 1/01/06 EACH OCCURRENCE $ 1000000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone firel $ 300000
I CLAIMS MADE W OCCUR MED EXP (Anyone person) $ 10000
. PERSONAL & ADV INJURY $ 1000000
I----
I-- GENERAL AGGREGATE $ 2000000
n'L AGGREFl L1MITAPn PER: PRODUCTS - COMP/OP AGG $ 2000000
POLICY ~~gT LOC
A ~TOMOBILE LIABILITY 21UECLl4905 1/01/05 1/01/06 COMBINED SINGLE LIMIT
lEa accident) $ 1000000
~ ANY AUTO
I-- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS IPer person)
I----
~ HIRED AUTOS BODILY INJURY
$
~ NON-OWNED AUTOS (Per accident)
I---- PROPERTY DAMAGE $
IPer accident)
RRAGE LIABILITY .
AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN ' EA ACC $
AUTO ONLY: AGG $
A EXCESS LIABILITY 21 SBALl1614 1/01/05 1/01/06 EACH OCCURRENCE $ 1000000
~'OCCUR ,0 CLAIMS MADE AGGREGATE $ 1000000
$
A DEDUCTIBLE 10000 $
RETENTION $ $
A WORKERS COMPENSATION AND 21WECDU9811 1/01705 1/01/06 I WC STATU- I 10TH-
TORY LIMITS ER
EMPLOYERS' LIABILITY
-.- - "-----, ,I" - - -"_.~ "- -- -- ------~----- - - - - -E;~;EACH ACCI6ENT $- 10000''00' ,--
E,L, DISEASE - EA EMPLOYEE $ 1000000
E,L. DISEASE - POLICY LIMIT $ 1000000
OTHER
DESCRIPTION OF OPERATlONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER IS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION.
CITY OF CLEARWATER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
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
CLEARW A TER FL 337584748 REPRESENTMflVES. /J ~
AUTH~ F}jP~~ ~/
I
.
ACORD 25-S (7/97) 45- 38 .. 1/ V r @ACORD CORPORATION 1988