CERTIFICATE OF INSURANCE (4)
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ISSUE DATE (MMiDD/YY)
10101/96
PRODUCER
nus CERTIfICATE IS ISSUED AS A MATIER OF INFORMATION ONLY AND
CONFERS NO RIGKI'S uPON TIlE CERTIfICATE HOLDER. nus CERTIfICATE
DOES NOT AMEND. EXTEND OR ALTER TIlE COVERAGE Afl'ORDED BY TIlE
POLICIES BELOW
Acordia SE, Central F1a Divsn
COMP AMES AFFORDING COVERAGE
P.O. Box 31666
Tampa, FL 33631-3666
COMPANY
LETIER A Western World Insurance
INSURED
COMPANY
LETIER
B
Reliance Special Risk
PINELLAS COUNTY EMERGENCY MEDICAL
SERVICES C/O RISK MANAG~~NT DEPT.
400 S. FT. HARRISON, 3RD F~OOR
CLEARWATER, FL 34616
COMPANY C
LETIER
American Empire Surplus
COMPANY
LETIER D
COMPANY E
LETIER
nus IS TO CERTIn' TIIAT TIlE POLICIES OF L'iSClU.-;cE LISTED BELOW HAVE BEEN ISSUED TO TIlE INSURED NAMED ABOVE FOR TIlE POLICY PERIOD
INDICATED. NOTWITIISTANDING ANY REQUlRnIE:'oT, TI!RM OR CONDITION OF ANY CONTRACT OR OTIlER DOCUMENT WITH RESPECT TO WHICH nus
CERTIfICATE MAY BE ISSUED OR MAY PERTAL'I, TIlE L'lSURANCE Afl'ORDED BY TIlE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL DIE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LllUTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAI~IS_
CO lYPE OF INSURANCE POLICY NUMBER POLICY EFr. POLICY EXP.
TR DATE (MMIDD/YY) DATE (MMIDD/YY)
LIMITS
A GENERAL LIABILITI
NGL..B539
10101/96
10101197
GEliERAL AGGREGATE $
PRO~O~IP/OP AGG.
PERS. .& ADV. INJURY
500,000
COMM. GENERAL LIABILITI
CLAIMS MADE Docc. s - 000
, :) , . . DED. PER CI:AIM
EACH CLAIM
fIRE DA-'IAGE(One FIre)
$
500 000
X AMBULANCE DRIVERS
& ATTENDANTS ~
B AUTOMOBILE LIABILITI
ANY AUTO
ALL OWNED AUTOS
X SCHEDULED AUTOS
IllRED AUTOS
NON-DWNED AUTOS
GARAGE LIABILITI
MED. EXP. (One Per)
SH165013610
10101/96
10101197
COMBI~'ED SINGLE
LI~IIT
$1,000,000
BODILY I:-uuRY
(Per penon)
BODILY IIiJURY
(Per accident)
PROPERTY DAMAGE
C EXCESS LIABILITI
UMBRELLA FORM
X ODIER THAN UMBRELLA FORM
5CXQ{;420
10101196
10101197
EACH CLAIM
WORKERS' COMPENSATION
AND
EMPLOYER'S LIABILITI
$
$
500,000
500,000
AGGREGATE
EACH ACCIDE1'oT
DISEASE-POLICY LIMIT
DISEASE-EACH EMP_
OTIlER
DESCRIPTION OF OPERATIONSILOCATIONSIVEIllCLES.'SPECIAL ITEMS
TIlE CERTIFICATE HOLDER IS NAMED AS .WDmONAL INSURED
AS TIlEIR INTEREST MAY APPEAR.
CITY OF CLEARWATER
CLEARWATER, FLORIDA
SHOULD A-'IY OF DIE ABOVE DESCRIBED POLICIES BE CA-'iCELLED BEFORE THE
EXPIRATION DATE TIlEREOF, DIE ISSUI:-IG COMPA-'W \\lLL E~nEAVOR TO
MAIL ...l!l..- DAYS WRlTI'E:-I :-IOTICE TO THE CERTIFICATE HOLDER :-lAMED TO TIlE
LEFT, BUTFAlLL'RE TO ~IAlL SUCH NOTICE SHALL I~IPOSE;';O OBLIGATION OR
LIABILITI OF'ANY KI~n ll'ON DIE COMPA-"lY, ITS AGE~TS OR REPRESEl\TATIVES.
JOHN L. HANDEL