CERTIFICATE OF LIABILITY INSURANCE (7)
Dale (mm/dd/yy)
Mary Whitten
9/20/2007
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.
Rebsamen Insurance, Inc.
1500 Riverfront Drive
Little Rock
501-661-4800
www.rebsamen.com
AR 72203
INSURER Ace American Insurance Company
INSURER Liberty Insurance Corp
Insured
Alltel Wireless Holdings LLC
P. O. Box 2177
Little Rock
INSURER
Lexington Insurance Company*
*Beecher Carlson Broker of Record
INSURER
AR 72203
INSURER
E
';- ,
INSR TYPE OF INSURANCE POLICY NUMBER LIMITS
LTR
GENERAL LIABILITY EACH OCCURRENCE $
A COMMERCIAL GENERAL LIAB XSLG23729052 10/1/2007 10/1/2008 FIRE DAMAGE (An one fire) $
CLAIMS MADE 00CCUR MED EXP An one erson) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS.COMP/OP AGG $
LOC $
A ISAH08233093 10/1/2007 10/1/2008 COMBINED SINGLE LIMIT $ 2 000 000
BODILY INJURY
(Per person) $
BODILY INJURY
(Per accident) $
PROPERTY DAMAGE
(Per accident) $
AUTO ONLY. EA ACCIDENT $
OTHER THAN EA ACC $
AUTO ONLY: AGG $
EACH OCCURRENCE $
XOOG23885530 10/1/2007 10/1/2008 AGGREGATE $
$
DEDUCTIBLE $
RETENTION $ $
WORKERS' COMPENSATION & W A 7 -640-005098-067 10/1/2007 10/1/2008 THER
EMPLOYERS' LIABILITY $
WC1-641-005098-087 10/1/2007 10/1/2008 $
$
RE: McMullen Booth (FI0182) City's "Del Oro Park Water Tank". Certificate
Holder is included as Additional Insured ATIMA.
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City of Clearwater
Real Estate Services Mgr.
Attn: Earl Barrett
P.O. Box 4748
Clearwater
FL
33758-4748
~~t1t:t{;t:~A'G.EIdlA't{(i) .
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
~DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION
OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRE.
SENTATIVES. .10 Days for Non-Payment of Premium
AUTHORIZED
REPRESENTATIVE
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