CERTIFICATE OF LIABILITY INSURANCE (33)
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CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDNYVY)
03/21/2007
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER (818)889-2155 FAX (805)379-4198
ISU Insurance Services License #OB50569
Stanton & Associates
3625 Thousand Oaks Blvd #319
Westlake Village, CA 91362
INSURED Skybox Mobile Medi a
5421 Ira St.
Orlando,FL 32807
INSURERS AFFORDING COVERAGE
INSURER A United National Insurance Compan
INSURER B:
INSURER C:
INSURER D:
INSURER E
NAIC#
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 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.
l!'l~~ ~~~! TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY DLROO02476 02/14/2007 02/14/2008 EACH OCCURRENCE $ 1,000,000
"x COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,OOC
I CLAIMS MADE [K] OCCUR MED EXP (Anyone person) $ 5,000
A X PERSONAL & ADV INJURY $ I,OOO,OOC
f--
GENERAL AGGREGATE $ 2 ,000,000
f--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
h .nPRO- n
POLICY JECT LOC
AUTOMOBILE LIABILITY DLROO02476 02/14/2007 02/14/2008 COMBINED SINGLE LIMIT
I- $
ANY AUTO (Ea accident) 1,000,000
-
ALL OWNED AUTOS RI ~CEIVED BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
A X -
X HIRED AUTOS BODILY INJURY
X $
NON-OWNED AUTOS AF R . ,- 2007 (Per accident)
- 11
- PROPERTY DAMAGE $
(Per accident)
. "
GARAGE LIABILITY lEGISLA IVE SRVCS DEI rr AUTO ONLY - EA ACCIDENT $
=1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA UABILlTY EACH OCCURRENCE $
~ OCCUR o CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I T"X~$imI,~~ r IOJ~-
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $
OFFICERlMEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $
--' ~~~tl~S~~~~~d~~SbelDW ---- " --- --< - -' -- --' -._--- - -,-- ELmS-EASE - POLIcY LIMIT $ --- -- --
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
ity of Clearwater is named as additional insured in respects to the above policy. RECEIVED
APR 1 0 2007
n'nl/ '.0' __.
. "...." .."".1 r
CE FICATE 0 ER
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Clearwater
112 South Osceola Avenue
Clearwater, FL 33756
@ACORD CORPORATION 1988
ACORD 25 (2001/08)
.. A..:..
POLICY NUMBER: DLR0002476
COMMERCIAL GENERAL LIABILITY
CG 20 26 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organlzation(s)
City of Clearwater
112 South Osceola Avenue
Clearwater, FL 33756
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section II - Who Is An Insured is amended to in-
clude as an additional insured the person(s) or organi-
zation(s) shown in the Schedule, but only with respect
to liability for "bodily injury", .property damage" or
"personal and advertising injury" caused, in whole or
in part, by your acts or omissions or the acts or omis-
sions of those acting on your behalf:
A. In the performance of your ongoing operations; or
--am-~nncctionwitlT-yotff- -premises ownect-by-or
rented to you.
CG 20260704
@ ISO Properties, Inc., 2004
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