CERTIFICATE OF INSURANCE FOR ENTRANCE MONUMENTS IN RIGHT-OF-WAY 2008
Jun-12-2007 07:48am From-
uto.Owners
INSURANCE COMPANY
6101 ANACAPRI BLVD., LANSING. HI 48917-3999
TAILORED
T-529 P.002/002 F-859
55040 (11/87)
Issued 03-21-2007
lION POLICY DECLARATIONS
Page
1
AGlENCY CARLISLE FIELDS S COMPANY INC
12-0025-00 MKT TERR 052 (727) 797-0441
INSURED MORNINGSIDE MEADOWS HOMEOWNERS
CIVIC ASSOC
POLICY
~al Effective 05-15-2007
952312-2D51781&-07
Am~~s PO BOX 5182
Company
B:i.ll
POLICY TERM
2:01 a.m. 12:01 a.m.
to
5-15-2007 05-15-2008
CLEARWATER, FL 33758-5182
In consideration of P~Y~.ht of the pre.ium shown beloH. this policY is renewed. leasg ~ttaeh thi$
Declarations and attachments to your policy. If you hava Bny questions, please c suit with your a98nt.
COMMERCIAL GENERAL L!AB!L!TY COVERAGE
LIMITS OF INSURANCE
General Aggreg~te
(Other Th~n P~oduets-Comp1eted Operations)
Products-Completed Operations Aggregate
Per50nal Injury And Advertising Injury
Each Occurrence
Damage to Premises Rented to You (Fire Damage)
Medic~l Payments
500, 00
500, 00
500, DO
50, 00 Any One Premises
5. 00 Any One Person
Twice the "Ganer~l Aggregate limit", shown above, is provided at 0 additional
charge for each 12 month period in accordance with forM 55300.
AUD!T TYPE: Non-Audited
FORMS THAT APPLY TO LIABILITY: 55084 (06-04) 59350 (01-06) IL DZl (11-85)
CG022D (07-92) IL0017 (11-85) 55146 (06-04) 55296 (07-05) 5 300 (07-05)
55163 (12-04) 55181 (12-04)
LOCATION OF PREMISES YOU OWN, RENT OR OCCUpy
LaC 001 BLDG 001 2296 Habersh~m Drive
C1~arwater, FL 33764
.
TERRITORY: 004
COUNTY: PinellQs
Classifi~ation Subline
CODE 41670
Homeown@rs I/Or Mobile Homeowners Pre~/O~
Associations - No Bui1din~s Or
Premises Owned Dr leased Except For
Office Purposes. Including Products
And/O~ Completed Operations.
(Not-For Profit)
premiulD
Basis
Rates
Each 1
1.024
Premium
Prem/Op Prem
350
$358.0
CODE 49950
Addi~ional In~erests
Designated Per/Organization L
City Of Clearwater
Prem/Op
If Any
$0.0
From: Dottie Booth At: Carlisle, Fields & Company FaxlD: 727-725-3663 To: Trish
Date: 6/1212007 09:15 AM Page: 30f3
Agency Code 12-0025-00
Policy Number 952312-20517816
COMMERCIAL GENERAL LIABILITY
55163 (12-04)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED · CONTROLLING INTEREST
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name o' Person or Organization:
CITY 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.
e. This insurance does not apply to structural alter-
ations, new construction ana demolition operations
performed by or for that person or organization.
C. Under SECTION III - LIMITS OF INSURANCE, the
following is added:
The limits of liability for the additional insured are
those specified in the written contract or agreement
between the insured and the controlling interest, not
to exceed the limits provided in this policy. These
limits are Inclusive of and not in addition to the lim-
its of insurance shown in the Declarations.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Copyright, Insurance Services Office, Inc., 1984, 2003.
Page 1 of 1
Jun-12-2007 07:48am From-
T-529 P.001/002 F-859
l1iels 11
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Date: C/;~ /;;2 007
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Fax Number: _
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