CERTIFICATE OF LIABILITY INSURANCE (8)
Jan-05-02 OB:I0A Mutual Ins Agency
727 442 9751
P.Ol---J
ACORD.
.QERTIFJC/(te:;qf.LfA8lLJTYJNSURAN;CEo.p:~:'.J> .':. OATE(MaWDIYY)
.. ... ...... .. .. .... ... .... .. ....... ...........HAR~...2-... 06/05/02
THIS CERTIFICATE IS ISSUED AS A MAnER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTlRCATE
HOLDER. THIS CERTIFICATE OOES NOT AMEND. EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
COMPANIES AFFORDING COVERAGE
PRODUCER
Mutual 1I18urance Agency
~t Clearwater, Inc.
P.O. Box 1779
CleArWater PL 33757-1779
John Gay
PIlon. No. 7-27-446-6064 Fax No. 727-442-9751
INSURED
r::ow>AHV
A Auto OWner.
COMPANY
B
Marina Dental ~ Denture
Clinic, P.A.
25 Cau.eway Blvd., Ste. 20
Cl.arwater FL 33767
COMPANY
C
ct:)Ul>ANY
D
:C(1V~r:S:::: . ...... ". .'.: ::.... . ... .":: : :
lliIS IS TO CERTIFY THAT THE POlICIES OF INSURANCE: LISTED BELOW HAVE BEEN ISSUED TO THe INSURED NANEDASOVE FOR THE POLICY PERIOD
INDICATED, NOTWlTHSTAM)ING ANY REQUIREMENT, lERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTifiCATE MAY BE ISSLED OR MAY PERTAIN. lHE IHSURANCE AFFORtED BY THE POlICIES DESCRIBED HEREIN IS SUBJECT TO ALL THe lERMS.
EXCLUSIONS AND CONOITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID ClAIMS.
.:.:. :::.:
CO
LTR
TYPE OF INSURANCE
POliCY NUMBER
POLICY efFECTIVE POliCY EXPIRATION
DATE (MM/DOIYY) DATE (U~OOYY)
LIMITS
GENERAL LIABILITY GENERAL AGGREGATE S 1000000
- 06/03/02 06/03/03
A ]I: COMMERCIAL GENERAL :JABILlTY 92-178132-00 PROOLICTS - COIoIPIOP AGO S
I::: I ClA'MS WADE ~ OCCUR PERSONAL & KJV INJURY S 1000000
OWNER"S & CONTRACT~S PROT EACH OCCURRENCE S 1000000
I--
FIRE DAMAGE (Any _ h) S 50000
I--
WED EXP (Ant _.--.) S 5000
AUTOlolOlILE LIABILITY COMaINEO SINGLE LIMIT S
I--
AMY AUTO
I--
ol\U. OWNED AUTDS BODL Y INJURY S
f-- (Pet ,.,..,)
SCHEDULED AUTOS
I--
I-- HRED AUTOS BODILY INJURY S
NON-OWNED AUTOS ("- acddenC)
f--
PROPERTY DAAtAGE S
GARAGE lIA81llTY AUTO ON. Y - EAACODENT S
- I:: ::.
ANY AUTO OTHER THAN AUTO ONlY:
-
EACH ACCIDENT S
-
AGGREGATE S
EXCESS L\AIlLITY fAC)f OCCURRENCE S
~ UMIlREUA FORM AGGREGATE S
OTHER THAN UM8RELl.A FORM S
WORKERS COWPENSATION AI'lD I ~R~It,~\'Ts I IO.I~ ::.::- '::...,
EAFl.OYEAS" LIA8LITY EL EACH ACCIDENT S
THE PROPRIETORI R~CL I!L DISEASE - POLICY LJIoIIT $
PMTNERSIEXEctmVE
OFFICERS ARE: EXC- EL DISEASE. EA EMPLOYEE S
OTHER
A Personal Prop. JtEPL. COST 50.000.
DESCRIPTION Of OPERATlONSJlOCATIONSlVElioCLESlSPEOAlITEMS
C.il:y of Clearwater 1. named as AdcS.itional :Insured.
AdcS.itional insured: City of Clearwater
'CI;R:n~~:~~~::;:;:::::;':'. ..... . :.::::::::::;:::::;:;:::::::::::::;:::;:::::;::::::: :::::;:::::::;:::::;:::;::~~~J;.t;Atl~;:;:;:;:;:::;:::::::::::::::;:::::::;:;:::::::;:;:'::.;:::;:::::::;::;;::::
CITI010 SI<<XJLD AHV Of THE ABOVE DESCRIBED POlICIES BE CANCaLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY W1U ENDEAIIOR TO MAlL
Ci t.y of Clearwa ter ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
rx 462-6957
Karboraas t.era Of f ice BUT FAILURE TO MAlL SUCH NOTICE SHAlL IMPOSE NO OBUCATION OR lIA8lLITY
2 5 C~u..w~y Blvd. OF ANY KIND LPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES
Cl.arwater PL 33767 AUTHORlZEDREPRESlENTAnVE
ACORJ)::~~$Oi'95V::::.: ::: . .::::: ::::: :::::::;;:;.:::::;:;:::;:::::::::-:;:::::::;:: ;::::~~;t\F~L<:'::;:;:::::::;::::;'::;:::::'::::-,ACQRI)~~()M.t!O~n988::
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