CERTIFICATE OF INSURANCE FOR ENTRANCE MONUMENTS IN RIGHT-OF-WAY 2007
Jun-12-200T 06:42am
From-
T-528 P,002/005 F-858
....... ...~... .... ". ~. ....................... --
For: Morningside Meadows Homeowners
Civie Assn. % William Murray
P.o. Box 5182
Clearwater, FL
33758-5182 539-5236
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Carlisle fields & Con pany, Inc
P.O. Box 7910
Clearwater, FL
33758-7910 727-; 97-0441
C;~vElraQ.e _ .
Amount, , Company , " "-,"
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General Liability
Auto Owners Insurance Company 20S1781606
05/15/06 05/15/07 362.0
Occurrence,
General Aggregate
Products/Completed Oper. Aggr.
Personal & Advertising InjulY
Each Occurrence
Damage to Rented Premises
Medical Expense (Any One Person)
500,000
500,000
500,000
500,000
50,000
5,000
1 Clubs, CiviC. Service or Social
Class Code 41670
Premium BasIs ~ 350 member
(T) OTHER
1 Additional Interests
Class COde 49950
Premium Basis ; If Any
UNKNOWN
Location 1
Add'llnsured: City of Clearwater
Jun-12-2007 OG:42am
From-
T-528 P,003/005 F-858
... ..., ........ .. ,. ..... . .. ...,., ... ., -.- .... ,. ... -
For; Morningside Meadows Homeowners
Civic Assn. % William Murray
P.o. Box 5182
ClealWater, FL
33758-5182 539-5236
.r:ft1..,~~:~u::__ ~.c.'~,I,~.~' . ._, ...,
Carlisle Fields & Cor: pany,lnc
P.O. Box 7910
Clearwater, FL
33758-7910 727w 97-0441
Co.v~.~a~e... ..
Amount
c..of!1pany "
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Commercial Application
Auto Owners Insurance Company 20S17!llfi06
05/15106 05/15/07 0.00
Premise 1 Building 1
2296 Habersham Drive
Clearwater, FL
33764
Jun-12-200T 06:42am From-
T-528 P.004/005 F-858
r-\ IIC:Y '''~moer 952312-2051"h:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE R AD IT CAREFULLY.
COMMERCIAL GENERAL L1AB'LI, ":5
55181 (1 ..(),,~
ADDITIONAL INSURED - DESIGNATED PERSON OR
ORGANIZA TION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE:
Name Of Additional Insured Person(s) Or Organization(s)
CITY OF CLEARWATER
...~.:
\~I
,
Information required to complete this Schedule, if not shown above, will be show in the Declarations.
A. SECTION /I - WHO IS AN INSURED is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule but only with
respect to liability for "bodily injury", "property
damage", "personal injury" or "advertising injury"
caused, in whole or in part, by YOllr acts or omis-
sions Or the acts or omissions of those acting on
yotAr beha'~f:
1. In the performance of your ongoing operrttion5;
Oi
2. In connection vith YOUr premises owned by or
rented to you.
B. The following is ad ed to SECTION III _ LIMITS OF
INSURANCE:
The limits of liabili v for the additional insured are
those specified in tt e written contract Or' agreement
between the insure and the desi9nated person or
organization, not tc exceed the limits frovided in
this poliey. These I mits 8f-e inclusive 0 end not in
Cidditioll to the lim ts of insurance shown in the-
Declarations.
'"
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Copyright, Insurance Services Office, Inc., 1984, 2004. Page 1 of 1
Jun-12-2007 06:42am From-
T-528 P.005/005 F-85B
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MMERCIAL GENERAL LIABILITY
55163 (12-04)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE REA IT CAREFULLY.
ADDITIONAL INSURED - CONTROLLIN ..I.NTEREST
This endorsement modifies insurance pro'Jided under the following:
,
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization:
CITV OF CLEARWATER
"
"
(if no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
A. SECTION II - WHO IS AN INSURED is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only with
respect to their liability arising out of:
Their financial control of you; or
Premises they own, maintain or control while
you lease or occupy these premises.
B. This insurance does not apply to structural alter-
ations, new construction and demolition operations
performed by or for tt:~t person or organization.
c. Under SECTION III LIMITS OF INSURANCE. the
following is added:
The limits of liabilit for the additional insured are
those specified in th written contract or agreement
between the insured and the controlling interest. not
to exceed the limits provided in this policy. These
limits are inclusive and not in addition to the lim-
its of insurance sho n in the Declarations.
.
Includes copyrighted material of Insurance Services Office, Inc.. wit) its permission.
Copyright, Insurance Services Office, Inc., 1984, 200' .
Page 1 of 1
Jun-12-2007 06:42am From-
T-528 P,OOI/005 F-858
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No. of Pages: 5 ,including cover page
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