CERTIFICATE OF LIABILITY INSURANCE
I DATE
03-16-2006
!jCORDTM . CERTIFICATE OF LIABILITY INSURANCE
i PRODUCER I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
, ' ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
IBROWN & BROWN PINELLAS/PHS I HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
221605 P: (866)467-8730 F: (877)538-8526 i ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO'BOX 29611 ,
CHARLOTTE NC 28229 INSURERS AFFORDING COVERAGE
INSURED iNSURER A: Hart ford Ins Co of the Southeast
i iNSURER B: Hart ford Underwriters Ins Co
GREENWOOD COMMUNITY HEALTH iNSURoR c:
11Q8 N. MARTIN LUTHER KING JR AVE. I iNSURER D:
CLEARWATER FL 33755 I INSURER E:
COVERAGES
'----rn:: POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
AN,Y 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
POi_ICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR I ' I I POLICY EFFECTIVE
.~ TYPE OF INSURANCE POLICY NUMBER ! DATE (MM/DD/YYI
i 'GEN ERAL LIABILITY I I
A ~'., COMMERCIAL GENER~ABILlTY 21 SBA BM23 86 I 05/02/06
CLAIMS MADE lliJ OCCUR I I
x Business Liab I
I
GEN'L AGGREGATE LIMIT APPLIES PER: I
! POLICY j~2T X LOC I
I POLICY EXPIRATION I
DATE (MM/DD/YYI
I EACH OCCURRENCE
05/02/07 I FIRE DAMAGE (Anyone lirel
I MED I'XP (Anyone personl
I PERSONAL & ADV lNJURY
I GENEllAL AGGREGATE
I PRODUCTS - COMP/OP AGG
LIMITS
$1,000,000
dOO,OOO
$10,000
!$1,000,000
$2,000,000
1$2, 000, 000
A
21 SBA BM2386
05/02/06
I COMEIINED SINGLE LIMIT
05/02 /07 (Ea accident)
$1,000,000
'AUTOMOBILE LIABILITY
ANY AUTO
i ALL OWNED AUTOS
,---,
i SCHEDULED AUTOS
X i HIRED AUTOS
_ __ fX : ,"'OW,", Aem,
f..GARAGE LIABILITY
I.-J ANY AUTO
, I
BODILY INJURY
(Per p8rson)
I BODI! Y INJURY
(Per accident)
I PROPERTY DAMAGE
(Per accident)
I AUTO ONLY - EA ACCIDENT $
I OTHER THAN EA ACC $
AUTO ONLY: AGG $
I I EXCESS LIABILITY I EACH OCCURRENCE $ I
1'-1 -
I i I OCCUR U CLAIMS MADE I AGGREGATE I $ I
1- L I $
R DEDUCTIBLE L I $
RETENTION $ I $
WORKERS COMPENSATION AND X I WC STATU- I IOl~i
I TORY LIMITS
IB EMPLOYERS' LIABILITY 21 WEC GC3515 10/03/05 10/03/06 i $100,000
E.L. EACH ACCIDENT
I II , E.L. DISEASE - EA EMPLOYEE I $1 0 0 , 0 0 0
,-- POLICY LIMIT 1$500,000
! I E.L. DISEASE -
] om," I I
I L
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
[se usual to the Insured's Operations.
CERTIFICATE HOLDER
! ADDITIONAL INSURED; INSURER LETTER:
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE I
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL I
30 DAYS WRITTEN NOTICE (10 DAYS FOR NON-PAYMENT) 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.
City of Clearwater Florida
Attn: Diane Huford
112 South Osceola Avenue
Clearwater, FL 33756
A~.:~_
ACqRD 25-5 (7/97)
ISJ ACORD CORPORATION 1988