CERTIFICATE OF LIABILITY INSURANCE (10)
';;:.
ACORD", CERTIFICATE OF LIABILITY INSURANCE RS~I DATE
P4SA 07-1a-2006
FfIO()fJf;Vl THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
BROWN & BROWN PINELLAS/PHS ONLY AND CONFERS 1\10 RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
224605 P:(866)467-8730 F:(877)53B-8526 ALTER THE COVERA.GE AJ:J:ORDED BY THE POLICIES BELOW,
PO BOX 29611
CliARLOTTE NC 2 B 2 2 9 INSUR!:RS AFFORDING COVERAGE
/Nl;/JREf1 INSumA: Hartford In6 Co of the Southeast
lN$UIlEIIB:
WILLA CARSON HEALTH RESOURCE CENTER INSU~(;:
1108 N. MARTIN LUTHER KING JR AVE. INSUR91 0:
CLEARWATER FL 337"'5 IN&UAEI1 E:
COVERAGES
TI-lE POLIC;II.::; L1~1 ~u BEI:OW I::;::;U~U I u ED NAMED ABOVE FOR TI-lE POLICY PERIOD INDICATED. NOTWIT1-l5TANOING
ANY REQUIREMENT. TERM 01'1 CONDITION OF A~ CONTRACT OR OTHER DOCUMENT W1TI-l RESPECT TO WJ.lICI-l TI-lIS CERTIFICATE MAY BE ISSUEO OR
MAY PERTAIN, TI-lE INSURANCE AFFOROEO 6Y TI-lE POLICIES DESCRf800 I-fERElN IS SUBJ~T TO AlL HIE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE UMITSSI-lOWN MAY I-lA~ BEEN REDUCED BV PAID CLAIMS.
~ TI'FE OF fNIi/JRANCE I'Of.ICY /'IIJMBEI/ ':8Wv l#1IECTtIIl I'OlICY 1!XI'IIIA.T/ON LINIn'S
~"1lJ. (WJltrrr EACH OCCURReN~ 31. 000 000
A I--- OMEFlCIAL lJl:Ne'lAL llA8lUTY 21 SBA BM2J86 05/02/06 05/02/07 RRE OAM"'GE (Any on. fire' $:300.000
I-- ClAIMS MADE [!] OCCUR ME!) EXP (..... 0... 0"'''''''' .10 - 000
~ Business Li~ PERSONAL & "'OV INJURY $1.000.000
I-- ~L.""Gt;FlliGATE: $2. 000 000
n'L AOO~n UMlT APfii PEFl: PIlOOOCT8 . COMP/op AGG .2 - 000. 000
POUCY ~gy. X LOC
~()M01Jt{1; llA./Plrrr 05/02/06 05/02/07 COMBINED SINGLE UMIT .1,000,000
A ANY AUTO 21 SBA BM2366 110> ...ldofOQ
I---
f---- AI.!. DWNE;D AUTOS BODILY INJURY 3
SCI-lEDULEO AUTOS 1F'r'D~SCIr\l
f----
Jl HIRED AUTO$ eOOlL Y INJURY
$
~ 1\IQN-<:IVl'tlEO P\\]TQ$ (Pol, ...idontl
f---- -...... PIlOPEFlTY DAMAGE .
(1'\0, ..cident'
R"t" UABlUTl' AUTO ONLY - EA AC<;IDENT $
/lNY AUTO 01'\.lER TIlAN EA Ace $
AUTO ONI.V: AGG ~
EJf.CeSS (1A/JIfJTY lOAtH OCCURRENCE C
t::) OCCUR 0 ClAIU8 MADE AGGREG4 TE S
$
R OEOUCTI~ $
RETElllTI CN $ .
vraRllEfIlS c()MPENSA 710N A/IO we STAT\I- IO~-
eM/'(OrERS' LfAB/UT'Y El.. EACH ACCIDENT $
E.L. OISEASE - EA EMPlOYEE $
E.L OI!'~E' OQJCY UI/II1' S
rn1fSII
()I!SCRIPT1OPI OF C1I'E/l/I11Ot'I1iIf.OCA TtrJNliIVI!f/ICUS/EXa IISfONS AODI:O IIY EAflJOIIS(lIRNTl!il'fClA( I't/f}VIS/OIV.'
Those usual to the Insured's operations.
CERTIFICATE HOLDER I "OfJI'TIr;1N14L ~o;~(errcR: CANCELLATION
SHOULD ANY OF TI-lE ABOVE. OE.SCRII;lr;o POLICII;S BE CANCELLED BEFORE THE
6XPlRATION DAn THEREOF. THE ISSUING INSURER WILL ENOEAVOR TO MAIL
City of Clearwater Florida 30 DAYS WRITTEN NOTICE (10 DAYS FoFl NON-PAYMENTI TO HIE CERTIFICATE
Attn; Diane Ruford HOLDER NAMED TO TI-lE lEFT, BUT FAllURI> TO DO so SHALL IMPOSE NO
OBLIGATION OR LIABILITY OF ANY KIND UPON TI-lE INSURER, ITS AGENTS OA
112 South osceola Avenue R~PRESENT A TIVES.
Clearwater, FL 33756 ~mr::/~'I71~
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ACORD 25-517/971
~ ACORD CORPORATION 1988
~
.A_CORDTM CERTIFICATE OF LIABILITY INSURANCE
RSH DATE
P4SA 07-18-,2006
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 AI=FORDED BY THE POUCIES BELOW.
/IIlOJWCI!R
BROWN & BROWN PINELLAS/PHS
224605 PI(B66)467-8730 FI(B77)538~8526
PO BOX 29611
CHARLOTTE NC 2B229
_fIRED
INSURERS AFFORDING COVERAGE
INSURell1\,Bartford Underwriters Ins co
WILLA CARSON HEALTH RESOURCE CENTER
1108 N. MARTIN LUTHER KING JR AVE.
CLEARWATER PL 33755
COVERAGES
INSURER 8'
INSURER c:
INSVREfl 0:
INSlR:fl E:
THE POLICIES OF lNSU~ANCE U5TEO llELOW HAVE llEElIllSSUEO TO THE fJll5UREO NAMED ABOVE FOR TI-IE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT. Tl:RM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMl:NT WITI-I RESPECT TO WI-IICI-I THIS C~IFICATE MAY 6E155Ul:0 OR
MAY PERTAIN. THE INSURANCE; AHORDE!) BY TI-l' POLICllOS D~RIBED HiRElN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
POUCII;S. AGGREGATE LIMITS SHOWN MAY HAV5< BEI;N REoUCED BY PAID CLAIMS.
~ TYPE OF 1III!IURA~ POlICy fiUMBfiR ~C:Y fI'Ff{;T~ f'l;ItA';Y fXI'IRA,TJfJN UllllTS
~Al1JlllJflJTY EACI-I OCCURRENCE $
f-- 3MERCI.o,L GENeIlI>.L LIAlIIUTY FIRE O"'MA\lE I...nv one n'el 8
'-- CLA,lIIAS M'IOE 0 0Q:;uI\ lAW EXP (A"y ""' 1W_1 ~
PEFllillNAL 6 AllV INJUflY $
GEN~L .o.ooIlEGp.,~ ~
n'L "'(lORen LIMI: APn Pl:1<, PRODUCTS - COMPIOP A,(l(l ~
PllUC;V ~7 u;JC;
~lft'OMOlJII.e lJA.61Ifl'l' COMBINED SlNGU: UMIT 8
ANY"'UTQ (~, .oc~nu
'--
- ALL OWNI<\) AUTOS IlODIL Y IN..IURY
e
SCHEDlIlE\) /l\IJtllS (Po, p......,
-
- H1RID AUTOS 600lL Y IN.,KJRY
11'0, .....",..1 $
- NON-OWNED AUT05
- PROPEIlTY DAMAGE ~
(~, ecdH!R1
. ~1IA(Of ~lA.f4fTV AUTO ONLY- EA ACCIDENT $
"'NV AUTO OTl-EFllllAN EAAC;C $
AUTO otIL y, ...00 $
EXCESS IIAB/UTV 'E~ OC;C:UFlFlENQ $
5oQ;;uPI 0 Q....M$ 1l/IAOe: AG_TE $
$
==iOEDUCTIBtE $
FlETENnQN . e
wnRlt1!RS tDWI;lIL'iA T70N AAID X I~STAl1J. IOJ,tl-
A EMPLOYERS' UA./J1UrV 21 WEC GC3515 10/03/05 10/03/06 u.. l;A.CH ...CC106\lT 8100.000
EJ... l:IISE.o.SE . ..... EMPl,.QVEl; $100.000
U.. OO&'e"'&\': -IIQLOeV OMIT ~SOO.OOO
OTHlill
QEIiC1f/I'Tlf]N OFOPEIlA ~OC'ATlDIIIIIi'Vi!'HaE5'EKClll:!ltWlJ IlDDEDDY E1'ID~CIAl. 'ROVf$IOfJS
Those usual to the Insured's operations.
CERTIFICATE HOLDER T A~t-"_{"'I!1I(~'" CANCELLATION
S\.IOUlD ANY m: TI-ll; ABOVI; DI;SCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDt:AVOR TO MAIL
City of Clearwater Florida 30 DAVS WRITTEN NOTICE (10 DAYS ~R NON-PAYMENTI TO T\.IE ceRTIFICATe
Attn: Diane Huford HOLDER NAMED TO THl: LEFT, BUT FAILURE TO 00 SO SI-IAlllMPOSE NO
PBLIGATlON OR LIABILITY OF ANY I<;INO UPON TI-IE INSURER. ITS AGENTS OR
112 South Osceola Avenue REPRESENTATIVES.
clearwater. FL 33756 AUnIORIZED~~Am;.
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ACORD 25.5 (7/97)
C ACORD CORPORATION 198a