CERTIFICATE OF LIABILITY INSURANCE
ACORDTM
CERTIFICATE OF LIABILITY INSURANCE
I DATE
08-25-2006
I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ljNLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
BROWN & BROWN PINELLAS/PHS
224605 P: (866)467-8730 F: (877)538-8526
PO BOX 29611
CHARLOTTE NC 28229
INSURED
INSURERS AFFORDING COVERAGE
INSUflERA:Hartford Ins Co of the Southeast
--------
INSURERS: Hartford Underwriters Ins Co
vHLLA CARSON HEALTH RESOURCE CENTER
1108 N. MARTIN LUTHER KING JR AVE.
l~LEARWATER FL 33755
COVERAGES
INSURER c:
INSURER D:
INSURER E:
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.
INSR TYPE OF INSURANCE POLICY NUMBER ~~~YJ~~~g~~~ "gk'fl/~rX'~~J,)~~ LIMITS
UR
I GENERAL LIABILITY I I EACH OCCURRENCE $1, 000, 000
A E ~MMERCIAL GENERAL LIABILITY 21 SBA BM2386 05 /02 / 0 6 05 / 0 2 /07 I FIRE DAMAGE (Anyone fire) I $300 ,000
:=J CLAIMS MADE ~ OCCUR I MED EXP (Anyone person) 1$10,000
~ Business Liab I PERSONAL & ADV INJURY I $1 , 000 , 000 I
I-- I GENERAL AGGREGA TE ~2 , 0 0 0 , 0 0 0
~'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG 1 $2 , 000 , 000
-I POLICY I -I j~gT iX-I LOC I I
~OMOBlLE LIABILITY COMBINED SINGLE LIMIT $1,000,000
IA ANY AUTO 21 SBA BM2386 05/02/06 05/02/07 (Ea accident)
'---
I - ALL OWNED AUTOS I BODILY INJURY l$
SCHEDULED AUTOS (Per person)
- ,
~ HIRED AUTOS BODILY INJURY
$
~ NON-OWNED AUTOS (Per accident) I
I PROPERTY DAMAGE I $
I (Per accident)
~RAGE LIABILITY I I AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC I $
AUTO ONLY: AGG $
~ESS LIABILITY _ EACH OCCURRENCE $
f-J OCCUR U CLAIMS MADE AGGREGATE $
$
=l DEDUCTIBLE $
I RETENTION $ $
I WORKERS COMPENSATION AND X 1r~~J>T~~;,T 1Ol~-
I B i EMPLOYERS' LIABILITY 21 WEC GC3515 10/03/06 10/03/07 $100,000
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE $100,000
-
I E.L. DISEASE - POLICY LIMIT $500,000
I I OTHER I l_ I ~KEIVED
I
DESCRIPTION OF OPERATlONS/LOCATlONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Those usual to the Insuredls Operations. ) 07 2006
1 ':')h:IC;Ai.. I<E<;i..::r::U-:>,-i.i\jL
;"EGISl.PJIVE 5RVCS D::':'
i
I
, --
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER:
ICity of Clearwater Florida
IAttn: Diane Huford
1112 South Osceola Avenue
I Clearwater, FL 33756
CANCELLATION
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 (10 DAYS FOR NON-PAYMENT) 10 THE CERTIFICATE
HOLDER NAMED TO THE LEFT. BUT FAILURE 10 DO SO SHALL IMPOSE NO
OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
REPRESENTATIVES.
A~~~_
ACORD 25-S (7/97)
fl ACORD CORPORA nON 1988
Ib~ 089. -eLl