REGULAR RENEWAL (2)
CERTIFICATE OF INSURANCE
The company indicated below certifies that the insurance afforded by the policy or policies numbered and
described below is in force as of the effective date of this certificate, This Certificate of Insurance
does not amend, extend. or otherwise alter the Terms and Conditions of Insurance coverage contained in any
policy numbered and described below.
CERTIFICATE HOLDER:
CITY OF CLEARWATER
-ADDITIONAL INSURED-
DEPT OF PARKS AND RECREATION
PO BOX 4748
CLEARWATER. FL 33758-4748
INSURED:
NORTHWOOD ESTATES HOA INC
POBOX 14732
CLEARWATER. FL 33766
I
I
I
I
I
I
I
I
I
I
I
I
I [ ] Other Liability
I
I AUTOMOBILE LIABILITY
I [ ] BUSINESS AUTO
I
I
I
I
I
I
I
I
I ] Umbrella Form
I
I
I
I
I
I [ ]
I
I
Should any of the above described policies be cancelled before the
expiration date, the insurance company will endeavor to mail
written notice to the above named certificate holder. but failure to
mail such notice shall impose no obligation or liability upon the
company, its agents. or representatives,
I
TYPE OF INSURANCE I
LIABILITY I
[X] Liability and I
Medical Expense I
[X] Personal and I
Advertising Injuryl
[X] Medical Expenses I
[X] Fire Legal 1
Liability I
J
I
I
POLICY NUMBER
& ISSUING CO,
77-PR-178050-0001
NATIONWIDE
MUTUAL FIRE
INSURANCE CO,
I POLICY I POLICY I
IEFF, DATE IEXP, DATE I
I 06-01-02 I 06-01-03 I
I I I Any One Occurrence, , , , , , , ,
I I I
I I I Any One Person/Org ",.."
I I I
I . I I ANY ONE PERSON". ,.", ,.,
I . ,l>~'~>- I Any One Fire or Exp 1 os ion
I ~-..<. ~-'''I'''~ ~.'f~~
.......... ~. . .: " -.. "-
J I "'-",'-.-tGe ral Aggregate* ",.",
I I~. L Prod/ Ops Aggregate* ,
I.. I 1-;
LIMITS OF LIABILITY
(*LIMITS AT INCEPTION)
$ 1. 000 . 000
$ 1. 000 , 000
$ 5.000
$ 100.000
$ 1. 000.000
$ 1. 000 . 000
/
~..
[ ] Owned
[ ] Hi red
[ ] Non-Owned
;:1 I,
<. r",":'..._ .'1 Bodi,ly Injury
<r.il" ~../ I (tach Person) .,'.""" $
I ". <" (.//:, ((Each Accident) ......., $
-'. \
I....,I./Property Damage
I I (Each Accident) ........ $
I 1 Combined Single Limit"" $
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
DESCRIPTION OF OPERATIONS/LOCATIONS
VEHICLES/RESTRICTIONS/SPECIAL ITEMS
EXCESS LIABI LITY
Each Occurrence""."." $
Prod/Comp Ops/Disease
Aggregate* '",.,'..".. $
STATUTORY LIMITS
BODILY INJURY/ACCIDENT ". $
Bodily Injury by Disease
EACH EMPLOYEE .." ,., ,., $
Bodily Injury by Disease
POLICY LIMIT ........... $
] Workers'
Compensation
and
Employers'
Liability
Effective Date of Certificate: 06-01-2002
Date Certificate Issued: 05-14-2002
Authorized Representative: LARRY T, AUSTIN
Countersigned at: 29275 US 19 NORTH
CLEARWATER. Fl ~
~