CERTIFICATE OF LIABILITY INSURANCE (5)AC ORD.
pponacEp
ERMTFZATE OF LIA
Oa k e s !6 s cHL ate s In s uxam eta
4111 Land 0 Laken Blvd . OS
Lend 0) Lakes FL 34639
Pnall,t No. 813-996-44 E,pasa.
Robert Patsy Smith
12220 Gardon Laito Cisocast
Odessa FL 3355E
'OOVERAOE5-.:•:•:-' •
• .- • •.- • . •,. . . .
otos is To CERNEY THAT THE POUCEES OF INSURANCE LISTED RELOW HAVE BEEN I.SSUal TO THE NUR ED NAMED AgavE, FOR THE POLICY PERIOD
NDICATED, NOT,IMTHSTANDING ANY REDD IRE uprr, TEAM ON CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT Fs WHICH THIS
CERTIDICATE MAY SE issurs OR MAY PIA, ThE INSURANCE. AFFORDED SY THE POLICIES ECSCRIBED HEREIN L IAJE:mr 1L ALL THE TERMS,
It•>'..oLumoas AND CONDITIONS DESUCI1 POLICIES, LIMITS SHOWN MAY RAM REDUCED BY PAID CLAIMS,
co EYPE OF lasuRARco POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRAMON
LTR mos fyttrinoro DATE (MM)DOPPO
LIMITS
GENERAL AGGREGATE $ 30 0 0 0 0
07/21/11 PlicDucrrs COMPIOF AGO
PERSONAL ADV INJURY S
I EACH OCCURRENCE
1LITYINSURA c'sk'
SKT,T04 0/1 -7
I M
FT
HIS CERTIFICATE ISISSUE15 AS A TT
MAPOF INFORMATION L
T
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOWER, THIS CERTIFIRDATE DOES NOT AMEND, EXTEND DP
ALTER THE,- COVERAGE AFFORDED 9Y THE'. POLICAES
COMPANIES AFEDRIONG COVERAGE
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I A Auto Owners Insurance CM,
comPaNy
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COMPANY
; GENERAL LABILITY
A I X COMMERCIAL GENERAL LIABILITY I 865812 79185725
CAS MD [Tic occuR
uwNER.s. & CONTRACTOR'S PROT
AltromoltiLE LIABILITY
I 1
A,I‘DF AUTO
i ALL OWNED AUTOS
I SCHENJLED AUTOS
IdIRED Auras
NON.OWNED AUTOS
OANAGR IAERLITNI
ANY AUTO
LIABIL ITY
UMBRELLA FORM
I, I OTHER THAN UMBRELLA FORM
WORKERS, COMPENSATION AND
I EMPLOYERS' LIABILMF
THE PRE,'PRIETORI INCI
FAPTHERSIMCUTIVE
OFFICERS ARE: , EXCL
OTHER
0 7 / 2 1 / 1 0
DESCRiPTION OPoaAT163csaocATION,SNEHICLES/SPECIAL FTEMS
t 300000
FIRE DAMAGE [Any orIel two)
I MED EXP (Any :re peoorm $ SOO
!! COMBINED SINGLE LIUIT
/ BODILY INJURY
Mee pbtr.,ori)
900I1Y INJURY
(POr ccide n
pilopER-ry DALIAGE
AuTo oNLy AX/DENT &
DINER THA,N Atrro ONLY: I '
FACIA
AGGREGATE
- -
I Rasa cocas rtFttc.F
A DISREGATE
7 -"I WC StAlLIL , 10114;
--_—.11,9RY. LIMO I„,
EL EACH ACCIDENT , $
II EI, sISA SE POLICY UNITY I $
i EL rtsAsE. EA EMPLOYED I $
I
440 are sec- 17-20, TR110 27s Rem , Hillsborough County City of
Clearwater in an scheduled named l'dsurPd on this poliy.
Cj, ty of Clearamter
Engin,eozing Department
Pa Oa Bolt 4748
Clearwater FL, 33753
CL &ARM
SHOULD ANY OF THE' ABOVE DESCE,IDED POLICIES DE CANCELLED REFORE THE
I ENEIRATION DATE THEREOF', THE INSUINO COMPANY MELL ENDEAVOR 1'0 MAD
r
30 DAys wi YEN NoEnDR TO 'THE CERTIFICATE MOI-pR I;IIIMED r THL: LEFT,
SUCH IN'OTCE SMALL t‘EPCDEE 11,6 041-1.D3KDoN MABILIP('
c E ANY KINILPUZON THE COMpANyolIcRACJIK-- OR ),E4FR ;',SEECIATIVILS
EE rTlVF 17/ /
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