CERTIFICATE OF LIABILITY INSURANCE (7)
ACORD..
CERTIFICATE OF LIABILITY INSURANCE
OP 10 DATE (MMlDDIYYYY)
MARIN-2 05 02 07
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
Mutual Insurance Agency
at Clearwater, Inc.
P.O. Box 1779
Clearwater FL 33757-1779
Phone: 727-446-6064 Fax:727-~42-9751
INSURED
Marina Dental & Denture
Clinic, P.A.
25 Causeway Blvd., Ste. 20
Clearwater FL 33767
INSURER A:
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
Auto Owners Insuranc
NAlC#
18988
INSURERS AFFORDING COVERAGE
COVERAGES OFFlrlJ11 --- .
THE POLICIES OF INSuRANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IND~~~Wl~~ ~"'LJ
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MA DEPT
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.
NSR~ TYPE OF INSURANCE POLICY NUMBER ~~~~1J~J.f~E I PQ~~...,Y(pPI~J!RN LIMITS
LTR DATE MMlDD
~NERAL LIABILITY EACH OCCURRENCE $ 1000000
A X X COMMERCIAL GENERAL LIABILITY 92-178132-00 06/03/07 06/03/08 u"I\'IA"~ ~ IE "t:N I t:u $ 50000
PREMISES Ea occurence}
'I CLAIMS MADE [iJ OCCUR MED EXP (Anyone person) $ 5000
PERSONAL & ADV INJURY $ 1000000
GENERAL AGGREGATE $ 1000000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COM PlOP AGG $
Jtl. -n PRo.h
X POLICY JECT LOC
~OMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
-
ALL OWNED AUTOS BODILY INJURY
-'-- (Per person) $
-'-- SCHEDULED AUTOS
HIRED AUTOS BODILY INJURY
- $
NON-OWNED AUTOS (Per accident)
I--
f-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSJUMBRELLA LIABILITY EACH OCCURRENCE $
=t OCCUR o CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I TORY LIMITS I IUJ~'
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT
ANY PROPRIETOR/PARTNER/EXECUTIVE $
OFFICER/MEMBER EXCLUDED? E.L. DISEASE. EA EMPLOYEE $
~reMtS~~~v'l~?O~S below E.L. DISEASE - POLICY LIMIT $
OTHER
A BPP/RC 92-178132-00 06/03/07 06/03/08 Contents 82060
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
City of Clearwater is named as Additional :Insured.
City of Clearwater
FX 462-6957
Harbormasters Office
25 Causeway Blvd.
Clearwater FL 33767
CANCELLATION
CIT10 1 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITYt:' NYJQN&tJPON THE INSURER, ITS AGENTS OR
,/ ,.
REPRESENTATIVES. ",
AUTHORIZED REPRESENTATIVE J
.....---." ..-
CERTIFICATE HOLDER
John Ga
@ACORDCORPORATION 1988
ACORD 25 (2001/08)