CERTIFICATE OF LIABILITY INSURANCE (7)1.CERTIFICA ? c OF LIABLE/"
PRODUCER
BROWN & BROWN OF FLORIDA INC/PHS
224605 P:(866)467-8730 F:(877)538-8526
P 0 BOX 29611
;CHARLOTTE NC 2.8229
INSURED
WILLA CARSON HEALTH RESOURCE CENTER 11108 N. MARTIN LUTHER KING JR AVE.
CLEARWATER FL 3 3 7 5 5 1 INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEp TO THE INSUREb 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 INSR -
N TYPE OF INSURANCE
GENERAL LIABILITY
A ,_ COMMERCIAL GENERAL LIABILITY
HGeneral CLAIMS MADE I X I OCCUR
X Liab
GEN1 AGGREGATE LIMIT APPLIES PER!
POLICY PRO-
JECT X LOC
AUTOMOBILE LIABILITY
A ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
X HIRED AUTOS
X NON-OWNED AUTOS
GA AGE LIABILITY
ANY AUTO
POLICY NUMBER
21 SBM R07532 05/02/1.0
1
21 SBM RQ7532
EXCESS LIABILITY
J OCCUR u CLAIMS MADE
DEDUCTIBLE
RETENTION d
WORKERS COMPENSATION AND
B EMPLOYERS' LIABILITY
OTHER
OFFICIAL.
21 WEC GC3515
"Y INSURAN,,L DATE
03-12-20.10
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.
INSURERS AFFORDING COVERAGE
INSURER A:Hartford Ins Co of the Southeast
I?uRERB:Hartford Underwriters Ins Co
INSURER C:--?
INSURER O: m
LIMITS
EACH OCCURRENCE _ "1,00o,000
0 5/ 0 2/ 11 FIRE DAMAGE (Any ane fire) 03 00 , 0 0 0
MED EXP (Any one person)
..
$10, 000
PFRSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE L,2 , 60 0, 0 0 0
PRODUCTS - COMP/OP AGG s2,000,000
05/02/10
05/02/11 COMBINED SINGLE LIMIT
(Ea accident) 1 000, 000
$1,
BODILY INJURY
(Per Person) S
1
BODILY INJURY
(Per accident) $
i
'EIVE® (PPROr accpPERTYident) DAMAGE $ Tµ
?l AUTO ONLY - EA ACCIDENT S
14 2010 OTHER THAN EA ACC $
AUTO ONLY: AGG $
ORDS AN
SRVCS DE,
10/03/09 10/03/10
DESCRIPTION OF OPERATIONS(LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Those usual to the Insured's Operations.
I EACH OCCURRENCE _ $
AGGREGATE 1$
$
X WC STATU- OTH-
T Y LIMITS ER
E.L. EACH ACCIDENT $100, 000
E.L. DISEASE - EA EMPLOYEE $100, 000
E.L. DISEASE - POLICY LIMIT $500,000
ADDITIONAL INSURED; INSURER LETTER:
City of Clearwater Florida
Attn: Housing Division
112 S OSCEOLA AVE
CLEARWATER,FL,33756
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 (10 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE
HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO
OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
ACORD 25-S (7/97)
ATIVE ry
1?' ACORD CORPORATION 1988