CERTIFICATE OF INSURANCE
PRODUCER (703)425-0929
Renzi & Co.
PO Box 11800
Burke, VA 22009
Aly Mason
INSURED Kimberly Home
1189 N.E. Cleveland St
Clearwater, FL 33755
FAX (703)425-0928
DATE (MMJDDIYYYY)
01/21/2003
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.
ACORD
1M
CERTIFICATE OF LIABILITY INSURANCE
INSURERS AFFORDING COVERAGE
INSURER A: Safeco Insurance
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
NAIC#
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDIN
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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~~~ DD~~ TYPE OF INSURANCE POLICY NUMBER "9!-.!E1arFECTI~f Pgk!fll~{fJ6~~N LIMITS
NSR DATE MMIDDNY
GENERAL LIABILITY CP 7767844A-NOK001 01/01/2002 03/01/2003 EACH OCCURRENCE $ 1,000,000
- PREMISES lEa o~ir~nce) $
X COMMERCIAL GENERAL LIABILITY 200,000
I CLAIMS MADE 00 OCCUR MED EXP (Anyone person) $ 10,000
A ~ ~ ~ PERSONAL & ADV INJURY $ ,',' ~ 1,000,000
GENERAL AGGREGATE $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000
h 'n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY CP 7767844A~NOK001 01/01/2002 03/01/2003 COMBINED SINGLE LIMIT
f--- (Ea accident) $ 1,000,000
ANY AUTO
f--
ALL OWNED AUTOS BODILY INJURY
f--- (Per person) $
SCHEDULED AUTOS
A 'X HIRED AUTOS
BODILY INJURY
f--- (Per accident) $
X NON-OWNED AUTOS
f--
f-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSJUMBRELLA LIABILITY EACH OCCURRENCE $
:=J OCCUR D CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I TORY LIMITS I IUE~-
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $
-If-yes,odescribe undel' ~-- , - - - ---- ~- ---- .- ~_>c_'._ __-'..c - E.LDlSEASE - POCICY LIlvtri" $ -'
SPECIAL PROVISIONS below
OTHER CP 7767844A-NOK001 01/01/2002 03/01/2003 LIMIT: $1,000,000
A ~ROFESSIONAL LIABILITY
DESCRIPTION OF OPERATIONS I LOCATIONS J VEHICLES J EXCLUSIONS ADDED BY ENDORSEMENT J SPECIAL PROVISIONS
UlDITIONAL INSURED: CITY OF CLEARWATER
THE CITY OF CLEARWATER
OLD COACHMAN ROAD
ClEARWATER, FL
CANCELLATION
SHOULD ANY OF TliE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, TliE ISSUING INSURER WILL ENDEAVOR TO MAIL
-.lO.- DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TliE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON TliE INSURER, ITS AG
AUTliORIZED REPRESENTATIVE
L.-
ORD CORPORATION 1988
CERTIFICATE HOLDER
Richard Renzi
ACORD 25 (2001/08)