CERTIFICATE OF INSURANCE (260)
Mutual Insurance Grou as res eets such insurance as is afforded b those co BM0068
Certificate of Insurance
This certificate is issued as a matter of information only and confers no rights upon you the certificate holder. This certificate is not an insurance policy and does not amend, extend, or alter the coverage
afforded b the olicies listed below.
This is to certify that (Name and address of Insured)
WELCH 1ENNIS COURTS, INC.
4501 OLD US HWY. 41
SUN CITY, FL 33586
~ M~~,.
is, at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is subject to a1l their terms, exclusions and conditions and
is not altered by any requirement, term or condition of any contract or other document with resoect to which this certificate mal' be issued.
Expiration Tvpe
Continuous*
EffJExp. Date(s)
02/28/2007 / 02/28/2008
Policv Number(s)
WC2-151-287929-0 17
Limits of Liabilitv
Coverage afforded under WC law of Employers Liability
the following states:
-
-
X
Extended
Policy Term
AL,FL
Bodily Injury By Accident
$1,000,000 Each Accident
Workers Compensation
Bodily Injury By Disease
$1,000,000 Policy Limit
Bodily Injury By Disease
$1,000,000 Each Person
General Aggregate-Other than Prod/Completed Operations
General Liability
Products/Completed Operations Aggregate
HC1aimS Made
Occurrence
Bodily Injury and Property Damage Liability
Per
Occurrence
Per Person /
On~anization
Retro Date
Personal and Advertising Injury
Other Liability I Othel' Liability
Each Accident - Single Limit - B. I. and P. D. Combined
Automobile Liability
Each Person
-
Owned
Non-Owned
Hired
Each Accident or Occurrence
-
Each Accident or Occurrence
.'
1-( I:: GETVI:: U
C License Holder: George Kenneth Todd III
o
M
)Vl
E
N
T
S
*If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date. However, you will not be notified annually of
the continuation of coverage.
Special Notice - Ohio: Any person who, with intent to defraud or knowing that he I she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or
deceptive statement is guilty of insurance fraud.
Important information to Florida policyholders and certificate holders: in the event you have any questions or need information about this certificate for any reason, please contact your local sales producer,
whose name and telephone number appears in the lower left corner of this certificate. The appropriate local sales office mailing address may also be obtained by calling this number.
Notice of cancellation: (not applicable unless a number of days is entered below). Before the stated expiration date the company will not cancel or reduce the insurance afforded under the above
policies until at least 30 days notice of such cancellation has been mailed to:
. M. ":1 i,' f, '. 'i
, '," . lr I.:'
'~',."I':~,~",,,I"" r~....^_......"""",_.f"'" _,"_
-----ni,..IIVV IJv!"C;ariiVi',-
Office: TAMPA,FL Phone: 813-264-6588
~(<"" " ~'.. (......,~,.. ~~;_.._.....
"(J \:-.., ,....,.~. ....- '"' ~..,.._~.......-e.......'''"'.'':'~''''.~'''''
~......._.' ........ .-r..."._ ~..............._."":\ .... _.
Certificate Holder:
City of Clearwater
100 S Myrtle Ave.
Clearwater, FL 34616
RECEIVED
AUDREY ACCETTA
Authorized Representative
MAR - 9 2007
RISK MANAGEMENT
Date Issued: 03/01/2007 Prepared By: LS