CERTIFICATE OF LIABILITY INSURANCE (8) FROM :!AD FAX K10, :813920-3267 Jun 13 201:3 0,3:18PM P2
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CERTIFICATE OF LIABILITY INSURANCE � 06113113
THIS CERTIFICATE IS ISSUF;;Q AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFOROLD BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT SFrWEEN THE ISSUING IN AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND T1iE CERTIFICATE HOLDFR,
IMPORTANT, If the cortificato holder is an ADDITIONAL INSURED,the policy(' )must be en d. if SUBROGATION IS WAIVED,subject to
the term ant!conailtlons of the"Icy,cartain policies may require an endomement- A statement on this Certificate doea not confer rights to the
Certificate holder In lieu of such andorsomont(s). — CONTACT
PRODUCER 727-531-68010
his Insuranca Group-Cirwtr
2653 McCcrmick Cr 727-531-6855 P"O" FAX
Clearwater,FL 33759 Lt=, AC No:
John Hislop 7--
i
—NAICN —
$N3UnFR A-Westfield Insuran,�e Proup 124112
Munro Hobert& Patricia Smith
12220 Garden Lake C1 rcle
Odessa,FL 33556
INWArA F,-
INSURFR F
COVERAGES CERTIFICATE,NUMBER: REVISION NUMBER-,
THIS IS TO CERTIFY THAT THE POIACIFS OF WSURANCE Lls,rED BELOWW KAV�- BEEN ISSUFF)To THE INSURED NAMED ABOVE FOR THE POLIFY PERIOD
PNDIGATED. NOTWTHSTANOtNG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHFR DOCUMENT WITH ReSpEr-T TO miGHTHiS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIOE-5 DESCRIBED HEREIN IS SUBJECT TO ALL THE, TERMS,
EXCLUSIONS AND CONDITION$QF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM$-
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0ENCRA.LAOJUT-Y
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P jAnv Orin pml�) 10100C
PERSONa&ADV INJURY 600,00(
aCNEPAL AGGRECATE 1,000,00C
GE N'L AGgkt ,E UhUr APPL,ES PER,
1,000,00(
PRC,
i POLICY L0 C
AL I MMOBILE UARtUTY MBINED S1r4LF UMIT
ANY AGMO
BODILY INJURY(pWponon) S
ALL&ANF 0 SCHEDULED
AWTA AUTV9 = SWILY INJURY IF- S
H`RED AUTOS 15PI-15FE A —----------
I AUTOS
UMHAT�'LLA UAS T
EACH OCCURRENCE
MALL
AGGREGATE
DED i ,RCIFINTION 3
--T—VFC—C.TAnJl OTH-'
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AND EMPLOYERS'UAJ3$UTY YIN
1*11Y PROPR�F-YORPARTNZRI�XEC,(,rTiVE
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t,L�WSEASE-EA LMFLOY 3
c#aKnw under
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OF9CRIP'nION OF OPMAnONS LOCA'MON6 t VCmC1.zs wtmwi ACORD 107,Awoonot Ramarke Schemylo„If atom dp4rA is mqu"d)
SaI,- 1720-Township 275-Range 17E, 0dausa, F-T
City 61' le na=aa as additional incur ad with rosp*ctz to "naral
liability
CERTIFICATE HOLDER CANCELLATION
CITYCL2
SHOULD ANY OF T14C ABOVE,DESCRIBED POLICIES BE CANCELLED BEFORE
TAI DATE THEREOF, NOTICE, WILL BE DEuVERED IN
City of Clearwater E EXACCOAOANCF WITH THE POLICY PROVJSION5.
PO Box 4748
Clearwater,FL 33758 AU rHQRRZW HFFRWI�NTATTA;
0 1988-2010 ACORD PO N. All rights reserved.
ACORID 25(201 W06) The ACIORD rmam and kW are registered morks of ACORD