CERTIFICATE OF LIABILITY INSURANCE (2)
.. CE.RTifFICATE -- DATE (MM/DDIYY)
ACORDN OF LIABILIT'{ INSURANC~ia~TR04 06/22/07
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Oakes & Associates Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4111 Land 0' Lakes Blvd. #108 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Land 0' Lakes FL 34639 COMPANIES AFFORDING COVERAGE
COMPANY
813-996-4111 A Auto Owners InSurance Co.
Phone No. Fax No. ,
INSURED COMPANY
B
COMPANY
Robert & Patsy Smith C
12220 Garden Lake Circle COMPANY
Odessa FL 33556 D
COVERAGES .. .i.i.....
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE (MM/DDIYY) DATE (MM/DDIYY)
GENERAL LIABILITY GENERAL AGGREGATE $ 300000
i---
A X COMMERCIAL GENERAL LIABILITY 861912 20363781 07/21/06 07/21/07 PRODUCTS - COMP/OP AGG $
I---- ~ CLAIMS MADE [!] OCCUR
PERSONAL & ADV INJURY $
i--- 07/21/07 07/21/08
OWNER'S & CONTRACTOR'S PROT 861912 20363781 EACH OCCURRENCE $ 300000
I----
FIRE DAMAGE (Anyone fire) $
I----
MED EXP (Anyone person) $
AUTOMOBILE LIABILITY
I---- COMBINED SINGLE LIMIT $
ANY AUTO
i---
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
HIRED AUTOS BODILY INJURY
- $
NON-OWNED AUTOS (Per accident)
-
-- PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
-
ANY AUTO OTHER THAN AUTO ONLY: :....i .......
-
EACH ACCIDENT $
-
AGGREGATE $
EXCESS LIABILITY ~ EACH OCCURRENCE $
~ UMBRELLA FORM R ~ ~ [E Wi ~ AGGREGATE $
OTHER THAN UMBRELLA FORM $
WORKERS COMPENSATION AND I ~cfRW~~Vis I IOTH- Ii. ....i ....
ER
EMPLOYERS' LIABILITY 2 - 2007 .::.
JUN EL EACH ACCIDENT $
,- THE PROPRIl::TORl u R ;x~LL " --------- -.-- - I -- ---- ----------- EL DISEASE - POLICY L1ivlrr' - . .. ~-
PARTNERS/EXECUTIVE $
OFFICERS ARE: EL DISEASE - EA EMPLOYEE $
OTHER CITY OF CLE ~RWATER
ENGINEERING I EPARTMENT
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESlSPECIAL ITEMS
440 acres sec. 17-20, TWP. 27s. , Rge. 17E . , Hillsborough County
CERTIFICATE HOLDER CANCELLATION ........
CLEARWA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
City of Clearwater ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Engineering Department BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
P.O. Box 4748
Clearwater FL 33758 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
ACORD 2S"S (1/95) 7;a;;;;;;/0i~ ii i'" ACORDCORPPRATIONF1988
..