CERTIFICATE OF LIABILITY INSURANCE
.
ACORDm
CERTIFICATE OF LIABILITY INSURANCE
OP ID L DATE (MM/DDNYVY)
ALLTE-8 12 30/05
THIS CERTIFICATE 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
Rebsamen Insurance Inc(LR)
1500 Riverfront Drive
Little Rock AR 72202
Phone: 501-661-4800 Fax:501-666-9592
ALLTELWireless Holdings LLC
P.O. Box 2177
Little Rock AR 72203-2177
INSURER A:
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
Ace American Insurance Company
NAIC#
22667
INSURERS AFFORDING COVERAGE
INSURED
Libert Insurance Corp*
Lexington Insurance Company
*Marsh USA Broker of Record
COVERAGES
THE POLICIES OF INSuRANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSRD POLICY NUMBER POL!!<Y Ef.f_E_C.:r1XE POL~_Y EXPL~~N LI MITS
LTR TYPE OF INSURANCE DATE iMM/DDNY DATE'(MMIDDNY
GENERAL LIABILITY EACH OCCURRENCE $ 1,850,000
-
A X COMMERCIAL GENERAL LIABILITY XSLG21714355 01/01/06 01/01/07 UAMAljt: $ 150,000
PREMISES (Ea occurence)
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5,000
PERSONAL & ADV INJURY $1,850,000
-
GENERAL AGGREGATE $ 9,850,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $1,850,000
Xl POLICY n j~8i n LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $2,000,000
A ~ ANY AUTO ISSH08219035 01/01/06 01/01/07 (Ea accident)
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
HIRED AUTOS BODILY INJURY
- $
NON-OWNED AUTOS (Per accident) ... .' ."
- "<'
- PROPERTY DAMAGE $
., (Per accident) "
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ..
4 ANY AUTO EAACC $ . .
OTHER THAN
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $10,000,000
A ~ OCCUR D CLAIMS MADE XOOG23571036 01/01/06 01/01/07 AGGREGATE $10,000,000
$
=1 DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND TWC STATU- I IUJ~-
X TORY LIMITS
B EMPLOYERS' LIABILITY 640-005098-016* 01/01/06 01/01/07 $1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
-.-.-- QfEICI;R1MEI\1.SER E,l<CLUD~D? ---- - 64lc~50-9.8.,..02~'!r_._. -OJ.-,l.O-1 ,106 .- O-l./...!ll-I 0 1- El-lllSEPSE~~APLOYEE .$..l,.-OOO-rOO.O .- ..
If yes, describe under $1,000,000
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT
OTHER
C Prop-Direct Risk 7086600 01/01/06 01/01/07 Limit 5,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
RE: McMullen Booth (FI0182) City's "Del Oro Park Water Tank". Certificate
Holder is included as Additional Insured ATIMA.
CERTIFICATE HOLDER
CANCELLATION
COOFCL2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
Real Estate Services Mgr. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Attn: Earl Barrett IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O. Box 4748
Clearwater, FL 33758-4748 REPRESENTATIVES.
A~IZf-7PRE~ENTATIVE
ACORD 25 (2001/08)
@ ACORD CORPORATION 1988