CERTIFICATE OF INSURANCE (259)
ACORD". I CERTIFICATE OF INSURANCE I ISSUE DATE
03/31/2006
PRODUCER This certificate is issued as a matter of information only and confers no rights
MCGRIFF, SEIBELS & WILLIAMS OF GEORGIA, INC. upon the Certificate Holder. This Certificate does not amend, extend or alter the
5605 Glenridge Drive - Suite 300 coverage afforded by the policies below.
Atlanta, GA 30342 COMPANIES AFFORDING COVERAGE
Company National Surety Corporation
A
INSURED Company The American Insurance Company
CompBenefits Corporation B
100 Mansell Court East
Suite 400 Company Homeland Insurance Co
Roswell, GA 30076 C
Company
- "-- - '-.------ ----, - -. - - _.. I.... _' 0._ _.."'... . .... .... -.. ." -- -
Company
E
This is to certify that the policies of insurance described herein have been issued to the Insured named herein for the policy period indicated. Notwithstanding
any requirement, term or condition of 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, conditions and exclusions of such policies. Limits shown may have been reduced by paid claims.
CO TYPE OF INSURANCE POLICY NUMBER EFFECTIVE LIMITS OF LIABILITY
LT EXPIRATION
A GENERAL LIABILITY MZX80856497 04/01/2006 EACH OCCURRENCE $ 1,000,000
IX] Commercial General Liability 04/01/2007 FIRE DAMAGE $ 1,000,000
D Claims Made IXI Occurrence MEDICAL EXPENSE $ 10,000
o Owners' and Contractors' Protection
D PERS. AND ADVERTISING INJURY $ 1,000,000
D GENERAL AGGREGATE $ 2,000,000
General Aggregate limit applies per: PRODUCTS AND COMP. OPER. AGG. $ 2,000,000
D Policy D Project IXI Location
A AUTOMOBILE LIABILITY MZX80856497 04/01/2006 COMBINED SINGLE LIMIT $ 1,000,000
o Any Automobile 04/01/2007 BODILY INJURY {Per nerson\ $
lXI All Owned Automobiles BODILY INJURY (Per accident) $
o Scheduled Automobiles
IX! Hired Automobiles PROPERTY DAMAGE (Per accident) $
!Xl Non-owned Automobiles COMPREHENSIVE $1000 deductible
D COLLISION $1000 deductible
B WORKERS' COMPENSATION WZC80940213 04/01/2006 WC Statutorv Limit I x I Other I I
AND EMPLOYERS' LIABILITY 04/01/2007 EL EACH ACCIDENT $ 1,000,000
EL DISEASE {Each emnlovee\ $ 1,000,000
EL DISEASE {Policv Limit\ $ 1,000,000
EXCESS LIABILITY EACH OCCURRENCE $
o Occurrence o Claims Made AGGREGATE $
..- . .-- . ..... -- .'. .
C MANAGED CARE E&O LIABILITY MCP085706 04/01/2006 Aggregate Limit $ 1,000,000
04/01/2007 $
$
$
$
City of Clearwater is included as Additional Insured on the General Liability and Automobile Liability policies referenced herein, as required by written contract,
subject to policy terms, conditions and exclusions.
CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO
MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF
ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
Authorized Representative //~:,)>/':', dS"i'" ....t
City of Clearwater
City Clerk
P.O. Box 4748
Clearwater, FL 33758 'Z~(7 )r~"'F
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