CERTIFICATE OF LIABILITY INSURANCE (6) Mar 15 2012 9: 40AM HP LASERJET FAX
ALLIEu
CIL-00
February 29, 2012
CST'` OF CITE WATER
100 MYRTLE AVENUE
CLEARWATER FL 33767
RE; Certificates of Insurance
Dear -' I ; Ohrvg ',5,iL:
Enclosed is an original and/or a duplicate Certificate of
insurance.
Thank you for the opportunity to serve you. if you have any
questions please feel free to contact me anytime .
Sincerely,
Maria Crowell
Account Representative
Enclosure
ALLIED SPECIALTY INSURANCE, INC.
10451 Gulf Boulevard,Troas=Islmd,Florida 33706-727 367-69M- 1 800 237-3355 -FAX 721367-5,695/1407
85 N-E Loop 410,Suite",San Antonio,Texas 79216-210141-1321 - 1800 235-8-n4-FAX 210 3 1-2050
MIX
"A"N,T I,I the!Certificate hoWer Ix mn AD UITIONA I L 11 INS I ORED,the poflcy(ies) nwvt be ondorsoO, if SURROGATION 16 WAIVED,su )act to
the lenns and :# 4 Itions of • certain v. es may requIre a n en4arx a etatement on I n I s o artill cote doe° not _ •.r rie to th it
holder cortificate
PROO=FRAIliad Specialty Inou--rance, Inc
10451 Gu-if d .,.......... w
Tre Urg 7s and, FL 33706
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500"237-3355
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insurance Cgo.parly 1128 66
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,e Coast -
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Causeway 'r -.
Clearwater Beach
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A LIABILITY
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AIJIMMONU LIABILITY
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OF SUBROGATION
CITY OF CLEAR:YMTER SHOULD ANY OPTH 1!ABIOVE DESCRIBED POLICIES BE CANCIELLSO VSFQRS
N011r,11 WILL BE DEUVERM IN
CLSARWATER FL 3a76? .• ... .
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Nar 15 2012 Si40AM HP LnSERJET FAX P. 3
POLICY NUMSER,. C?P 0100575 02 COMMERCIAL GENERAL LIABILITY
CG 20 26 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This entlomement modifles,Insurance provided under the following:
COMMERCIAL GE LIABILITY COVERAQE PART
SCHEDULE
Name Of Additional Insured PeroonU* OLOr
CITY OPP C4ZARWATER
P 0. Box 4748
FL 33 76 7
.Information re wired to coml2late this Schedule, If not shown above, will be-shown In the Declarptigns.
SectIon 11 - Who Is An insured Is amended to in- sloes or the acts or omissions of those acting on
dude as an additional Insured the person(s) or or- your behalf-
ganization(s) shown in the Schadulie, but only with A. In the performance of your ongoing operations-,
respect to liability for "bodily Injury", 'property or
darrege" or "personal and adverNsIng Injury"
caua4b, in whole or In part, by your acts or orris- B. In conneatIon with your premises owned by or
rented to you,
CO 20 26 07 04 Copyright, ISO Properties, Inc., 2004 Page I of 1
UNIFORM