CERTIFICATE OF LIABILITY INSURANCE (6)
!,.
Jul
28 06
04:15p
CERTIFICAT!'OF LIABILITY INSURAN6i!'
727 - 442--8. 1S 1
p. 1
ACORD..
OP 10 DATE (MMlDO/YYYY)
MAR:IN..2 07 31 06
THIS CERTIFICATE I'd ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFEI .8 NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERnFICATE DOES riOT AMEND. EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
Mutual Insurance Agency
at Clearwater, Inc.
P.O. Box 1779
Clearwater FL 33757-1779
Phone:727-446-6064 Fax:727-442-9751
Marina Dental & Denture
Clinic, P.A.
25 Causeway Blvd., Ste. 20
Clearwater FL 33767
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
Auto Owners
NAlC#
18988
INSURERS AFFORDING COVERAGE
INSURED
COVERAGES
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 AI><< CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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.
LTR INSR TYPE OF INSURANCE POLICY NUMBER ~YM~~E P8ATE IMMlDD~N I UMITS
~NERAL UABILITY EACH OCCURRENCE Is 1000000
A ~ COMMERCiAl GENERAL LIABILITY 92-178132-00 06/03/06 06/03/07 PREMISES rEa occurence) Is 50000
~ :::::J CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $ 5000
I-- PERSONAL & ADV INJURY S 1000000
~- GENERAl AGGREGATE S 1000000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG S
II nPRO- n
POLICY JECT LOC
AUTOMOBILE UABLITY COMBINED SINGLE LIMIT
--- S
AI><< AUTO (Ea accident)
I--
ALL OWNED AUTOS BODILY INJURY
f-- S
SCHEDULED AUTOS (Per person)
~
HIRED AUTOS BODILY INJURY
- S
NON-OWNED AUTOS (Per accident)
-
PROPERTY DAMAGE $
(per aCCidant)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ AtoN AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA UABILITY EACH OCCURRENCE $
:=J OCCUR D CLAIMS MADE AGGREGATE $
$
=l DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND ITDRY uMmi I IU~~-
EMPLOYERS' UABIUTY
ANY PROPRIETOR/PARTNERlEXECLlTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
~~~~11ts~~t'v'i~foNS below E.L. DISEASE - POLICY LIMIT $
OTHER
A Personal Prop. REPL. COST 50,000.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
City of Clearwater is named as Additional Insured.
Additional insured: City of Clearwater
CERTIFICATE HOLDER
City of Clearwater
FX 462-6957
Harbor.masters Office
25 Causeway Blvd.
Clearwater FL 33767
CANCELLATION
CIT1010 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAnoN
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTIC, 0 E CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPO E NO L TION 0 LlABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REP SENT A ES.
AUTH ED RESENT TIVE
@ACORD CORPORATION 1988
ACORD 25 (2D01/08)