CERTIFICATE OF INSURANCE (16)
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LA~RY AUSTIN AGENCY
PAGE El2/El2
CERT~ ICATE OF INSURANCE
The company indicated below certlfies that: he insurance afforded by the policy or policies numbered and
described below is in force as of the effec: ive date of this certificate. This Certificate of Insurance
does not amend, extend. or otherW1se alter, he Terms and Conditions of Insurance coverage contained in ~ny
pOlicy numbered and described below,
CERTIFICATE ~OLDER:
CITY OF CLEARWATER
PO BOX 4748
CLEARWATER. FL 33758
INSURED:
NORTHWOOD ESTATES HOMEOWNERS
ASSOCIATION INC
POBOX 14732
CLEARWATER, FL 33766-4732
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I [ ] Other Liability
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I AUTOMOBILE LIABILITY
I [ J BUSINESS AUTO
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I ( ] Umbrella Form
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Should any of the above described policies be
expiration date. the insurance company will e
written notice to the above named certificate
mail such not1ce shall impose no obligation 0
company. its agents. or representat1ves.
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TYPE OF INSURANCE I
LIABILITY I
eX] Liability and r
Medical Expense I
Personal and I
Advertising Injury/
[X] Medical Expenses I
[X) Fire Legal ,
L1ability I
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POLICY NUMBER
& ISSUING CD.
77-BP-178050-3001
NATIONWIDE
MUTUAL FI RE
INSURANCE CO,
I POLICY I POLICY I
/EFF, DATE IEXP. DATE I
I 06-01-05 I 06-01-06 I
I I I Any One Occurrence.... .... $ 1.000.000
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I I I Included in Above - Any One Person or
I I / Organization
I I , ANY ONE PERSON ,.'...,.,.. $
I I I Any One Fire or Explosion $
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I I I Genera 1 Aggregate* ",..,. $ 2.000.000
I I , Prod/Cemp Ops Aggregate* . $ 1.000.000
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LIMITS OF LIABILITY
(*lIMITS AT INC~PTION)
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5,000 I
50.000 I
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DESCRIPTION OF OPERATIONS/LOCATIONS
VEHICLES/RESTRICTIONS/SPECIAL ITEMS
( ] OWned
[ ] Hi red
[ ] Non-Owned
Bodlly Injury
(Each Person) ..."...., $
(Each Accident) .,'..." $
Property Damage
(Each Accident) ....".. $
Combined Single Limit.." $
EXCESS LIABILITY
Each Occurrence ....,.. ... $
Prod/Camp Ops/Disease
Aggregate* ., ......., .,. $
] Workers'
Compensation
and
] Emp1 oyers '
L i abil1 ty
STATUTORY LIMITS
BODILY INJURY/ACCIDENT .,. $
Bodily Injury by Disease
EACH EMPLOYEE ......".. $
Bodily Injury by Disease
POLICY LIMIT ..,...,.", $
ancelled before the
eavor to mail
older, but fa1lure to
liability Upon the
Effective Date of Certificate; 06-01-2005
Date Cert1ficate Issued: 09-14-2005
Author1zed Representat1ve:
Co~ntersigned at:
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