CERTIFICATE OF INSURANCE
ACORD..
CERTIFICATE OF LIABILITY INSURANC~~!~ T DA:;;:~
THIS CERnFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
Wallace Welch . Willing".... Z11c::
300 First Avenue South, Sth Fl
P.O. Box 33020
st. Petersburg I'L 33733
PhaDe:727-S22-7777 Fax: 727-521-2902
INSURED
INSURER A:
INSURER 8:
INSURER c:
INSURER D:
INSURER E:
INSURERS AFFORDING COVERAGE
CClII1tin8J1tal Casualty Co./CJriIA
Ameri trust 3:118 Co
PersClll1&l BDrichmez1t ~
Hen. tal Health Sevice~L~:IDe.
11254 SBth Street BO~
pinellas ParkFL 33782
COVERAGES
T1iE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED 10 11tE INSURED NMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
AN'( REQUIREMENT, TERM OR CONDITION OF AN'( CONTRACT OR ontER DOCUIlENT WITH RESPECT 10 WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 10 ALL THE TERUS, EXClUSIONS AND CONDmoNS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. DATE~
'~fG TYPE OF INSURANCE POLICY NUMBER DATE UIIITS .
~ENERAL UABIUTY EACH OCCURRENCE $ 1,000,000
A X COMMERCIAL GENERAL LlABIUTY 1082313387 10/01/02 10/01/03 RRE DAMAGE (Any _h) $ 100,000
.. I CLAIMS MADE ~ OCCUR MEO EXP (Any _ person) $ 15,000
PeRSONAl. & AOV INJURY $ 1,000,000
GENERAL AGGREGATE $ 3,000,000
GEN'L AGGREGATE LIMIT APPUES PER: PRODUCTS - COMPlOP AGG $ 3,000,000
I POLICY n ~ fil LOC
AUTOMOBILE UABIUlY COMBINED SINGLE LIMIT $1,000,000
-
A X ANY AUTO 1082313387 10/01/02 10/01/03 (Ea 1ICddent)
-
ALL OWNED AUTOS BODILY INJURY.
- (Per pel$<<I) $
SCHEDULED AUTOS
-
~ HIRED AUTOS BODn..y INJURY
(Per acddent) $
~ NON.QWNED AUTOS
I
- PROPERTY DAMAGE $
(Per accident)
q==UTY AUTO ONLY - EA ACCIDENT $
OTHER THAN EAACC $
AUTO ONLY: AGG $
EXCESS UABIUTY EACH OCCURRENCE $ 1,000,000
A ~ OCCUR D CLAIMS MADE 1082313387 10/01/02 10/01/03 AGGREGATE $1,000,000
$
~ DEDUCTIBlE $
X RETENTION $ 10000 s
, 'NORI<ERS COMPENSATION AND X I TORY LIMITs I Ivar
B EMPLOYERS' UAB;UTY 10020211500 07/01/02 07/01/03 E.L EACH ACCIDENT $ SOO, 000
E.L DISEASE - EA BFLOYEE $ SOO, 000
E.L DISEASE - POLICY UMrT $ SOO, 000
OTHER
A Professional Liab 1082313387 10/01/02 10/01/03 Ba 3:ncdnt 1,000,000
Am:\. Agog 3,000,000
DESCRIPTION OF OPERATlONSILOCATIONSNEHICLESlEXCWSIOMS ADDED BY ENDORSEMENTISPECIAI. PROVISIONS
.'
CERTIFICATE HOLDER IN I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
C3:CLBAJl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATlO~
City of Clearwater DATE TliEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAlL ...1il.- DAYS WRITTEN
City Ball NOncE TO THE CER11FtCATE HOLDER NAMED TO THE LEFT, BUT FAlWRE TO DO so SHALL
Attn: Barl Jones IMPOSE NO OBLIGATION OR UABILITY OF ANY KIND UPON 11tE INSURER, ITS AGENTS OR
112 S Osceola Avenue
Clearwater FL 33756 REPReSENTATIVES.
~ ~~.
I
" / RATION 1988
CORD 25-& (7197)
CACORD CORPO