CERTIFICATE OF LIABILITY INSURANCE (195)A� Q� pATE (MM/D�/YYYY)
��- CERTIFICATE OF LIABILITY INSURANCE �p�zg/2011
THIS CERTIFICATE IS ISSUED AS A MAl'7�R QF IN�QI2MA714N ONLY AND CpNFERS ND RIGHTS UPON TH� CERTIFICATE HOL�ER. THIS
CERTIFICATE �OES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORb�D BY TH� PdLICIES
BELOW. THIS CERTIFICAT� OF INSURANCE DDES NOT CONSi17U7� A CON7'RAC7 BETWEEN THE ISSUING INSUR�R(5), AUTHORIZ�D
REPRESENTATIVE OR PRObUCER, AND tNE CERiIFICATE MOLDER.
' IMPOR7AN7': If the certificate holder is an A�DI7IDNAL INSURED, the policy(fes) must be endorsed. If SUeROGATION IS WAIVED, SUb]ECt t0
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certiflcate holder In Iiau of such endorsement(s .
PRODUCER Mutual Insurance Inc CONTACT Mitchell Marsh ext 2214
1900 1st Ave North PHONE �727� $96-OOOB F^X .(727) 821-7483 �
PO Bvx 12350 ��"�"�� mmarsh@mutualinsuranceinc.com
StPetersburg FL 33713 iucuvcorc�eccnoniur_rnvconr_e ����«
wsuReo
Harvard Jolly, Inc.
2714 Dr Mlk Jr St N
St Petersburg FL 33704-2722
Auto Owners Insurance Co
18988
GOVEl7AGE5 CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY TMAT TME POLICIES QF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSl1RE� NAMEQ AB�VE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, 7�RM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSl1E� pR MAY PERTAIN, THE INSURANC� AFFORDE� BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL TME T�RMS,
EXCLUSIONS AND CONDITIONS OF SUCH f'OLICIES. LIMITS SMOWN MAY MAVE BEEN REDUCED 8Y PAID CLAIMS.
oeNer�n� uneiurr
COMMERCIAL GENERAL LIABILITY
CLAIMSM,4�E � OCCUR
GEN'L AGGREGATE LIMIT APPUES PER:
POLICY PRa LOC
q auronnoei�.� waeiwrr X 967'7117000
^ ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON-OWNE�
X HIRED AUTOS X AUTOS
UMBRELLA L1AB OCCUR
excess une aanns-ro
WDRKERS COMPEN8ATION
ANG EMPLOY�RS' LIABILITY
ANY PROPRIETORlPARTNER/F�CECIITIVE
(Nlandatory in NH)
If ves. describe under
'"' ",:;'..�'�'. h1/fl8/a091 11/08/2012
��aV � �� %.���
,..h,'�: �. �,. �„� � .,',.`,.
�....,,.,_°,��?1�. .._., .. ,+'»��'
DAMAGE TO RENTE�
S
COMBINED SINGLE LIMIT
Bp�ILY INJURY (Per person) $
BODILY INJURY (Per accident) S
PROPERTYDAMAGE $
S
�ir���YOe
DESCRIPTION OF OPERAiIONS / LDCATION$ I VEHICLES (Attaeh ACpRD 701, Addltlonal Remerks Schedule, If more space Is requlred
The City of Clearwater is an additional insured as per the Commarcial auto policy with a waiver of subrogaiion in favor of the additional insured.
30 days notice of cancellation.
TE HOLDER
City of Clearvvater
Attention: City Clerk
PO Box a7as
ClEarvvater
ACORD 25 (2010/D5)
1,000,000
1,000,000
� ,�00,�00
AI 009139
SHdl1LD ANY OF THE ABOVE QESCRIBED POLICIES BE CANC�LLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCpFt�ANCE WItH TH� POLICY PROVISIONS.
FL 33758-4748 AUTHORIZED REPRE$ENTATIVE
, � —
Fax: ()- O 1888-2010 ACQRD CQRPpRATION. All rights reserved.
The ACORD name and logo are ragistered marks of ACORD