CERTIFICATE OF INSURANCE FOR ENTRANCE MONUMENTS IN RIGHT-OF-WAY 2004
f ,..~~~"
."~'i.~LOF TI/t;r~
~'!':...:.\ 1)"ff~LT.r.l...#C;7~_
.... ~.~ ..,.......,~'.....
,~,,\ I ~~.,.-...
~,~\~,\ 1/ ... j, ~. ~ ~
.,. ~.- -'." , ..
..c--,. = c:::(~
..w:::.~. ~--.::. . ~. ~
...-' ~ - -~~ ;::::.,
"':?.A. -~- ,,~;,
~';~$.C##c,.rl""~~'"
.-#-,-,~TE~"..tt
I'..rl~ ,
CITY OF CLEARWATER
POST OFFICE Box 4748, CLEARWATER, FLORIDA 33758-4748
Ci1Y HALL, 112 SOUTH OSCEOLA AVENUE, CLEARWATER, FLORIDA 33756
TELEPHONE (727) 562-4090 FAX (727) 562-4086
OFFICw.. RECORDS AND
LEGISLATIVE SERVICES
li
. L
APR S 0 2003
April 17 , 2003
CITY (,
Morningside Meadows Homeowners Civic Association
C/o Bill Zimmerman
P. O. Box 5182
Clearwater, Florida 34618-5182
Re: Agreement with City of Clearwater for Monument in Right-of-Way
To Whom It May Concern:
I am hereby requesting an insurance certificate from the Homeowners Association naming the City of
Clearwater as an additional insured with regard to the monument structures your association has placed
in the City right-of-way at the entrance to the subdivision. The agreement dated April 4, 1995 requires
that you carry liability insurance naming the City as an additional insured. Your current policy expires
May 15,2003.
If you have any questions, please contact me at 727/562-4097.
Sincerely,
.t~ 'Jd;JV&1./
Susan Stephen:/t1/u/,
Document & Records Supervisor
GtJCLOS€ ()
~c.. ,V\sort.~Y\c.e
,~
A
CoPy
Pot '<:7
o.f
/ss
End.
~el kl2.ee -h CCl(\ ~e \~
you. ~(:\~e o..rl7 tveS+lo,:$
B',\\ 2i V\'\tv'e(" rv>-an
7 '}l- 53\ -(Cl93
*
"EQUAL EMPLOYMENT AND AFFIRMATIVE ACTION EMPLOYER"
Carlisle Fields & Company, Ine
P.O. Box 7910
Clearwater, FL 33758-79]0
Phone: 727-797-0441 Fax: 727-725-3663
Morningside Meadows Homeowners
Civic Assn. % William Murray
P.O. Box 5182
Clearwater, FL 33758-5182
.... .........
: :Wr-dC :p.~~:p~i~T:tti .: typ.~:
............ .
........... .
. . . , . . . . . . .
363738 OS/J 5/03 REN GL-S
t~~~:~:
INVOICE#
75443
:.::~~;.:.:,:.:.:.
MORNl-l
.. ..........
:.:.: :.:.:~.~~.:.'.'
. ..OP....
NP
04/14/03
................ .
. . . . . . . . . . . . . . . . .
. -...............
. . . . . . . . . . . . . . . . .
...........'... .
.,............ .
.............. .
.............. .
<':'!J~...~~.'.'.' . .
:.:.:.:.:.::::::::::: C.ene:i:at itaiiii~y':(jj~li)
..................... .
205]78]603
Auto Owners Insurance Company
," ~t:'~CTJVE ',' ','
::::~~~J~~~~::' :.:...... . '. '.".......:. ~~i;~ri~~~u~ti~::::.:.:
05/15/03
05/15/03
05/15/04
. . . . . . . . . . . . . .
.... .'......
. ........
............... .
..... ...
........., .
: :P~$~r-,~ii~~:::::::::::::
03' -04' GL Renewal
Invoice Balance:
PA~O
4\~'61()3
eh~C, K "* \q'l'1
4J3Co~.aCJ
: P.ilg~::
......... .
......... .
....,.... ,
.......... .
......... .
. . . . . . . . . . . . . . .
......... .
. ...
.....,.... .
........ .
........ .
. . . . . . . . .
........ .
........ .
. . . . . . . . .
.Aiti~~~C :
... .........
...,....... .,<.....
$
362,00
$
362.00
Carlisle
((Fie1ds& Company~
N SUR A NeE
April 14,2003
Momingside Meadows Homeowners
Civic Assn. % William Murray
P,O. Box 5182
Clearwater, FL 33758-5182
Re: General Liability
05/15/03 to 05/15/04
Dear John:
We are pleased to enclose at this time your renewal policy. We have checked for accuracy and
hope you will find everything in order.
In addition to these coverages we also provide a full range of employee benefits as well as
Insurance and Estate planning for our valued customers; CFM Financial Services has been
providing these and other related services to our clients for many years. Should you have any
questions in these areas our representative, Brad Pettit, will be happy to help you!
If you have any questions on the coverages provided, or would like any information regarding
the additional services we offer please don't hesitate to call.
Sincerely,
Carlisle Fields & Company
I\ II ~ ..J ,
}UJW>>J
Debbie Day/NP
Customer Service Agent
2460 GULF TO BAY BLVD' CLEARWATER, FL 3~;765 . PO BOX 7910' CLEARWATER, FL 33758.7910' (727) 797-04.1'; . TOLL FREE (800) 797-0441 . FAX (72'7) 725-3:0[3
@CARLlSLE FIELDS & COlviPAI\V
AGENCY 12-0025-00
roUCY 952312-20517816
13271 (8-99)
CARLISLE FIELDS & CO INC
PO BOX 7910
CLEARWATER, FL 33758
03-26-2003
Life Home Car Business
~i\bIk~~fI
BOX 30660, LANSING, MICHIGAN 48909-8160 · 517/323-1200
AUTO-OWNERS INSURANCE COMPANY
AUTO-OWNERS LIFE INSURANCE COMPANY
HOME-OWNERS INSURANCE COMPANY
OWNERS INSURANCE COMPANY
PROPERTY-OWNERS INSURANCE COMPANY
SOUTHERN-OWNERS INSURANCE COMPANY
MORNINGSIDE MEADOWS HOMEOWNERS
CIVIC ASSOC
PO BOX 5182
CLEARWATER, FL 33758-5182
Thank you for allowing Auto-Owners to handle your insurance needs.
Auto-Owners Insurance Group is financially sound with sufficient reserves to be ranked among the leaders in the in-
dustry for financial security, Our A + + (Superior) rating by the A.M, Best Company signifies that we have the finan-
cial strength to provide the insurance protection you need.
Feel free to contact your Auto-Owners agency with any questions you may have about your insurance needs. Your
agency's phone number is (727) 797-0441.
@
Auto-Owners Insurance - The "No Problem" People
'-> Serving OW" Policyholders and Agents {OJ" MOl"e Than 85 Years '->
. Agency Code 12-0025-00
Policy Number 952312-20517816
54803 (4-02)
NOTICE TO POLICYHOLDER
AMENDMENT OF INSURING AGREEMENT - KNOWN INJURY OR DAMAGE
Dear Policyholder:
The COMMERCIAL GENERAL LIABILITY coverage provided by this policy is amended by form number 55229 (1-02)
AMENDMENT OF INSURING AGREEMENT-KNOWN INJURY OR DAMAGE. In accordance with the terms of this form,
coverage will not be provided for bodily injury or property damage that is known or should have been known prior
to the policy period.
This is for informational purposes only.
Please review this new endorsement and your policy carefully. If you have any questions concerning this exclusion,
please contact your Auto-Owners Agency.
Age~y Code 12-0025-00
Policy Number 952312-20517816
59343 (2-03)
NOTIFICATION OF CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM
Dear Policyholder:
The Terrorism Risk Insurance Act of 2002 was signed into law on November 26,2002.
Subject to policy terms and conditions, the attached policy provides insurance coverage for acts of terrorism as de-
fined in the Act.
Endorsement 59350 has been attached to this policy which provides you with both important information regarding
terrorism risk insurance coverage and caps our liability in accordance with the Act.
This notice is for informational purposes only,
If you have any questions concerning your policy or this notice, please contact your Auto-Owners agency,
.Auto-Owners
Page
55039 (1l-87>
Issued 03-26-2003
TAILORED PROTECTION POLICY DECLARATIONS
INSURANCE COMPANY
6101 ANACAPRI BLVD., LANSING, MI 48917-3999
Renewal Effective 05-15-2003
AGrnCy CARLISLE FIELDS & CO INC
12-0025-00 MKT TERR 068 (727) 797-0441
INSURED MORNINGSIDE MEADOWS HOMEOWNERS
CIVIC ASSOC
POLICY NUMBER 952312-20517816-03
ADDRESS PO BOX 5182
Agency
Bill
POLICY TERM
12:01 a.m. 12:01 a.m.
05-15-2003to 05-15-2004
CLEARWATER, FL 33758-5182
In consideration of payment of the premium shown below, this policy is renewed. Please attach this
Declarations and attachments to your policy. If you have any questions, please consult with your agent.
COMMON POLICY INFORMATION
BUSINESS DESCRIPTION: Homeowners Assoc
ENTITY: Homeowners Assoc
THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PART(S).
THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT.
COMMERCIAL GENERAL LIABILITY COVERAGE
PREMIUM
$362.00
TOTAL
$362.00
FORMS THAT APPLY TO ALL COVERAGE PART SHOWN ABOVE (EXCEPT GARAGE LIABILITY, DEALER'S
BLANKET, COMMERCIAL AUTOMOBILE, IF APPLICABLE)
55000 (01-87) 59350 (02-03)
Countersigned By:
-Auto-Owners
Page
1 55040 (11/87)
Issued 03-26-2003
TAILORED PROTECTION POLICY DECLARATIONS
INSURANCE COMPANY
6101 ANACAPRI BLVD., lANSING, MI 48917-3999
Renewal Effective 05-15-2003
AGE~Y CARLISLE FIELDS I CO INC
12-0025-00 MKT TERR 068 (727) 797-0441
INSURED MORNINGSIDE MEADOWS HOMEOWNERS
CIVIC ASSOC
POLICY NUMBER 952312-20517816-03
ADDRESS PO BOX 5182
Agency
Bill
POLICY TERM
12:01 a.m. 12:01 a.m.
05-15-2003 to 05-15-2004
CLEARWATER, Fl 33758-5182
In consideration of payment of the premium shown below, this policy is renewed. Please attach this
Declarations and attachments to your policy. If you have any questions, please consult with your agent.
COMMERCIAL GENERAL LIABILITY COVERAGE
LIMITS OF INSURANCE
General Aggregate limit
(Other Than Products-Completed Operations)
Products-Completed Operations Aggregate limit
Personal And Advertising Injury Limit
Each Occurrence limit
Fire Damage limit
Medical Expense limit
$500,000
500,000
500,000
500,000
50,000 Any One Fire
5,000 Any One Person
"General Aggregate limit" shown above, is reinstated once per policy period at no
additional charge, in accordance with form 55050.
AUDIT TYPE: Non-Audited
FORMS
55081
55050
55137
59246
THAT APPLY TO LIABILITY:
(08-88) 55029 (07-87)
(07-87) 55064 (07-87)
(06-92) 55146 (07-96)
(05-00) 55145 (12-01)
55084 (11-95)
CG0001 (11-88)
C1175 (02-86)
55160 (11-95)
55229 (01-02)
55118 (08-91>
CG0220 (07-92)
55069 (01-88)
55163 (11-95)
Il0021 (11-85)
Il0017 (11-85)
CG2147 (09-89)
55181 (11-95)
LOCATION OF PREMISES YOU OWN, RENT OR OCCUpy
LOC 001 BLDG 001 2296 Habersham Drive
Clearwater, Fl 33764
TERRITORY: 004
COUNTY: Pinellas
Classification Subline
Premium
Basis
Rates
Each 1
1. 024
Premium
CODE 41670
Homeowners I/Or Mobile Homeowners Prem/Op
Associations - No Buildings Or
Premises Owned Or leased Except For
Office Purposes. Including Products
And/Or Completed Operations.
(Not-For Profit)
Prem/Op Prem
350
$358.00
CODE 49950
Additional Interests
Designated Per/Organization l Prem/Op If Any
City Of Clearwater
$0.00
FOREIGN TERRORISM - CERTIFIED ACTS SEE FORM 59350
$4.00
lOCATION 001 PREMIUM
$362.00
, AgeAcy Code 12-0025-00
Policy Number 952312-20517816
55163 (11-95)
COMMERCIAL GENERAL L1ABI L1TY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - CONTROLLING INTEREST
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART,
SCHEDULE
Name of Person or Organization:
CITY OF CLEARWATER
(if no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
1.
WHO IS AN INSURED (Section II) is amended to in- 3.
clude as an insured the person(s) or organization(s)
shown in the Schedule, but only with respect to their
liability arising out of
a. Their financial control of you; or
b. Premises they own, maintain or control while
you lease or occupy these premises.
This insurance does not apply to structural alter-
ations, new construction and demolition operations
performed by or for that person or organization.
2.
The following is added to LIMITS OF INSURANCE
(Section III):
8. The limits of liability for the additional insured
are those specified in the written contract or
agreement between the Insured and the con-
trolling interest, not to exceed the limits pro-
vided in this policy. These limits are inclusive
of and not in addition to the limits of insurance
shown in the Declarations.
Includes copyrighted material of Insurance Services Office, Inc., with its permission
Copyright, Insurance Services Office, Inc., 1984
. Age\'lcy Code 12-0025-00
Policy Number 952312-20517816
55181 (11-95)
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLlCY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization:
CITY OF CLEARWATER
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
1. WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the
Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or
rented to you,
2. The following is added to LIMITS OF INSURANCE (Section III):
8. The limits of liability for the additional insured are those specified in the written contract or agreement be-
tween the Insured and the designated person or organization, not to exceed the limits provided in this policy.
These limits are inclusive of and not in addition to the limits of insurance shown in the Declarations.
Includes copyrighted material of Insurance Services Office, Inc., with its permission
Copyright, Insurance Services Office, Inc., 1984