CERTIFICATE OF INSURANCE (5)
AUG-01-03 11,28 FROM,WALKER TAYLOR AGENCY INC 10,8105088008 PAGE 1/2
.i1CaR~ CERTIFICATE OF LIABILITY IN::iUHAN\;t: 08/01/2003
PRQgUCI;R (910)509-9000 FAX (910) S09-9OO6 lHIS CERTIFICATE 1$ ISSUED AS A MATTER OF INFORMATION
Wal ker Taylor Agency Ine . ONLY AND CONFERS NO RIGHTS UPON THE CER11FICATE
'. HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
1430 Connonwea l1:h DrlVe #302 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Wilmington. NC 23403
1N$UR1!D McKlm & Creed, PA
P.O. Box 806
Wilmington. NC 28402
INSURERS AFFORDING COVERAGE NAJC #
JNSuReRA: Hanford Fire Insurance Co
~ Eli: Hartford Ins Co of the Midwest
INSUI'lER~
INSUflER D:
INSURER E:
COVERAGES
TH~ POUCIES OF INSURANCE usrE:O BeLOW HAVE BEEN IssueD TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWrTHSTANDINC
~Y REQUIREMENT, iERM OA CONDITION OF ANY CONrAACT OR OTHeR DOCUMENT WITH RESPECT TO WHICH THIS camFlCATE MAY BE ISSUE:O OR
MAY peRTAIN, THE INSURANCE AFFORDED 6YTHE POUClES DESCRI66> HEAEIN IS SUBJECT TO AU. THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
FQUCIES. A~GiREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Ilf:~ TYpEOFINSU~ PO\JCY NUMBER I'OUCY EFI'EC'TlVS POUCY EXPIRATION UMI1'$
as.IERAL uAERU'N 22UUNIA9447 05/15/2003 05/15/2004 EACH OCCURRENCe s l,OOO.OOfJ
X COMMERCIAL GeNeRAl UA8IUlY DAMAGE 'to FlENlW $ 300.00
I CI"AIU$ MADE m OCCUR MEO EXP (Attlone~) $ 10.00
A X PERSOW\L a AI)V ~URY $ 1.OOO,OOl
- 2.000.0~
GENERAL AGGREGAte S
~ PRODUCTS. COMP.QP AM $ 2,000.000
GEN.... AGGREG;AlE UMIT APl>uE.S PeR;
I PQUCY fXl ~ n LOC
AUroUOIlILE L1A81Lm' 2ZUENAM06S4 05/15/2003 05/15/2004 COMBINED SlNGt.E l.IMlT $
"':":"" ~ ..oc;dMt) 1.000.000
X Nof'( AlJTO
-
ALL OWNEO AIJlQS BODILY IN.lURY S
- (Pwlr~)
SCHeOULED AUTOS
A X X HiReD ALm>S
BOOIL Y lNJUf'lY $
X NON-OWNED AlJTOS (Per 1IllCid4Jnl)
-
- PFIOPER'IY DAII4AGC $
(Per~
GARAGe UASlUTY AUTO ONLY - EAACClcerr S
=i ANY AUTO OlliER 1'lfAIIl EANX $
AUlOONLY: AGGi S
~Dr:lEI..LA LIAIiIlU'l'V 2ZXHUUA0618 05/15/2003 05/15/2004 e.o.cH OCCURRENCE $ 4,Ooo.ooQ
!JoeeoR o CLAIMS MACe AGGREBATe $ 4.000.00
A X s
~ oeOUCTJel.,l; s
X RETENTION $ 10.000 oS
wOR1CeI:&$ OOMPENSATION ANO 22WBIG6643 05/15/2003 05/15/ZOO4 X rwc STATU- I IOJ~
EMPWY'&RS' UABIUTY E..L EACH ACCIDENT $ 1. OOO,GO
B AN'( PROPRII01'ORIPAATNEMiXSClJT1VE eL DlSiASE - eA IOMPLOYe $ 1.000,00
oFFJCeI/MeMeCR 5XCWDED?
I( ~ deaCllbe \I1Id9r EL OrSeASEi - POLICY LIMIT $ 1,000.00
s ECIAL PFlovlSlONS ~
O1l1ER
..- r>~r>n\V1ffi ,.....,
DeSCfltPTlON Of' OPERATlON$/ I.OCAllONS' V$lI(:LES/ ElCCt.USION$ ACCED BY ~ I SPECIAl.. PROVISION$ ~~-4~ l~
Policy Conditions and Exclusions apply.
CITY OF CLEARWATER
PUBLIC WORKS ADMINISTRATION
RTlF
LA
SHOULOAXV OF lHE AtJt:NE DESCfIl8EO l'OUaES Be ~o eEFORE THE
eJCPIRAllON ClA.1E TMEREOF, THe I$StIlNG INSURER WILL. ENtIEAVOR TO MAIL.
~ DAYS wRI'rT&N NOTICIl TO THE CERTIFICATE HOl..DER NAMED 10 1M.. LEFT.
BUT FAlWAE! 10 MAIL SUc:H NOTICfi SHAU-IMPOSli NO OBUGA~ OR UABIUTT
OF ANY KINO UPON lHE IN$IJAER.ITS AGENr$ OR REPRES~TA11YES.
AtmlORIZEDREPABENTAnvE bc..b~ &
l)eborah Church
City of Clearwater
Aun: Dina Katsougrakis
Municipal Services BUilding
100 SOuth Myrtle
Clearwater. FL 3l7S6
ACORD 25 (2001108) FAX: (727)461- 3827
@ACORD CORPORATION 1988
AUG-01-03 11,30 FROM,WALKER TAYLOR AGENCY INC
10,8105088008
PAGE
2/2
IMPORTANT
If 1he certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A $l:a1ement
on this oertifical& does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED. subject to the terms and conditions of the policy, certain policies may
require an .ndorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the r.verse side of this form doeS not constitUte a contract between
the issuing in$Urer(s), authorized representative or producer, and the certificate holder. nor does it
affinnatively or negatively amend, extend or alter the coverage afforded by the policies listed there:on_
ACORD 25 (2001108)