CERTIFICATE OF LIABILITY INSURANCE (2)
ACORDTM
CERTIFICATE OF LIABILITY INSURANCE
I
I DATE
04-09-2007
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
BROWN & BROWN OF FLORIDA INC/PHS
224605 P: (866)467-8730 F: (877)538-8526
PO BOX 29611
CHARLOTTE NC 28229
INSURERS AFFORDING COVERAGE
INSURERA:Hartford Ins Co of the Southeast
IINSURERB:Hartford Underwriters Ins Co
I INSURER C:
I INSURER D:
INSURER E:
INSURED
WILLA CARSON HEALTH RESOURCE CENTER
1108 N. MARTIN LUTHER KING JR AVE.
CLEARWATER FL 33755
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.
INSR TYPE OF INSURANCE POLICY NUMBER r:i~rM~~~~~ "8:t.fll:,xJl~~J.J~~ LIMITS
LTR
~NERAL LIABIUTY EACH OCCURRENCE $1,000,000
A ~MERCIAL GENERAL LIABILITY 21 SBM RQ7532 05/02/07 05/02 / 0 8 i FIRE DAMAGE IAny one. firel $300,000
"--
I-- ~ CLAIMS MADE~ OCCUR I MED EXP (Anyone person) 1$10,000
X Business Liab PER<lONAL & AOV INJURY $1.000,000
I GENERAL AGGREGATE 1$2,000,000
~'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS - COMP/OP AGG $2,000,000
-I POLICY I I ~rgT i X I LOC
AUTOMOBILE LIABlUTY I I
I-- 05/02/07 i COMBINED SINGLE LIMIT 1$1,000,000
A I-- ANY AUTO 21 SBM RQ7532 o 5 / 0 2 / 0 8 ! lEa aCCident!
"-- ALL OWNED AUTOS BODILY INJURY I
$
SCHEDULED AUTOS IPer personl
I--
~ HIRED AUTOS ! I BODIL YINJURY I
$ t
~ NON-OWNED AUTOS , IPer acCident! [
I PROPERTY DAMAGE I $
IPer acCident!
GARAGE LIABILITY I I AUTO ONLY - EA ACCIDENT I $
R ANY AUTO OTHER THAN ~-
AUTO ONLY: AGG $
~ESS LIABILITY EACH OCCURRENCE $
o OCCUR U CLAIMS MADE AGGREGA TE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X 1 WC STATU-, I IOl~-
TORv'i IMITS
B EMPLOYERS' L1ABlUTY 21 WEC GC3515 10/03/06 10/03/07 $100,000
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE $100,000
.. - - .. $500, ODD
E.L. DISEASE. POLICy LIMIT
OTHER
---- Jr: f"\
kil-l
DESCRIPTION OF OPERAnoNS/LOCATlONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Those usual to the Insured's Operations. t.~AY 0 J 2007
OFFICIAL RECORDS AND
LEGISLATIVE SRVCS DEpr
CERTIRCATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE I
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
City of Clearwater Florida 30 DAYS WRITTEN NOTICE (10 DAYS FOR NON.PAYMENT) TO THE CERTIFICATE I
Attn: Diane Huford HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO
112 South Osceola Avenue OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENT A TIVES.
Clearwater, FL 33756
A~er~~- o' j
ACORD 25-S 17/97) 0 ~'\ - c. \.e... ("' '<-
~c. - R. \ oS \;--
Ii) ACORD CORPORATION 1988