CERTIFICATE OF LIABILITY INSURANCE (15)
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ACORD.M CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYI
12/08/05
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Acardia 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 Image One INSURER A: HARTFORD INSURANCE GROUP
Image One Corp dba INSURER B:
INSURER c:
6206 Benjamin Rd #301 INSURER 0:
;rampa 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.
I~~: TYPE OF INSURANCE POLICY NUMBER ~OLlCY EFFE~:tY,~ P!?k!fEYf~~)~~lJ~~ LIMITS
A ~NERAL LIABILITY 21SBALl1614 1/01/06 1/01/07 EACH OCCURRENCE $ 1000000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ 300000
1 CLAIMS MADE W OCCUR+ MED EXP (Anyone personl $ 10000
PERSONAL & ADV INJURY $ 1000000
GENERAL AGGREGATE $ 2000000
n'L AGGREn LIMIT APn PER: PRODUCTS - COMP/OP AGG $ 2000000
POLICY ~~Ri- LOC -
A ~TOMOBILE LIABILITY 21 UECLl4905 1/01106 1/01/07 COMBINED SINGLE LIMIT
(Eo accident) $ 1000000
---K- ANY AUTO
- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
-
---K- HIRED AUTOS BODILY INJURY
$
---K- NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accidentl
.==jAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A EXCESS LIABILITY 21SBALl1614 1/01/06 1/01/07 EACH OCCURRENCE $ 1000000
::KJ OCCUR D CLAIMS MADE AGGREGATE $ 1000000
$
g DEDUCTIBLE $
X RETENTION $ 10000 $
A WORK EllS COMPENSA'T10N AND 21WECDU9811 1/01/06 1/01/07 I WCSTATU-l IOTH-
iORY LIMITS ER
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT $ 1000000
E.L. DISEASE - EA EMPLOYEE $ 1000000
E.L. DISEASE - POLICY LIMIT $ 1000000
OTHER
RECEiVer)
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS GEe 0 \} 20u::
CERTIFICA TE HOLDER IS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY
OFFICIAL RECORDS AND
LEGISLATIVE SRVCS DEPT
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 --1Q.. 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 REPRESENTJldifvES. ./J
AUTH~---'PR~~ ~
I
ACORD 25-5(7/97) 45- 38 ~ U v , @ACORD CORPORATION 1988
-
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 25-5 (7/97)