CERTIFICATE OF LIABILITY INSURANCE (2)
ACORDN CERTIFICATE OF LIABILITY INSURANCE OP 10 lx..9 DATE (MMlDD/YYYY)
ABILI-l 11/12/04
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Hockman Lackey Insurance, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
3438 Colwell Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tampa FL 33614
Phone:813-636~4000 Fax:813-281-1086 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: First Natl Ins Co of Americi!
INSURER B: Nationwide Mutual InsCo
Abilities Inc of Florida INSURER C: American States Ins Co
Gene Thomas
2735 Whitnet Road INSURER 0: General Ins Co of America
Clearwater L 33760
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE lISlED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, lERM 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR NSR[ TYPE OF INSURANCE POLICY NUMBER DATE /MMlDDIYYJ DATE MMlDDIYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
-
A X COMMERCiAl GENERAL LIABILITY 25CC0017142 11/07/04 11/07/05 P~EM;S~S (~~~~~nce) $200,000
I CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $10,000
PERSONAl & ADV INJURY $1,000,000
I---
I-- GENERAl AGGREGA lE $3,000.000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPfOP AGG $3,000,000
~POllCY n ~r8i n LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $1,000,000
B ANY AUTO 77BA7332583001 09/30/04 09/30/05 (Ea accident)
-
ALL OWNED AUTOS BODILY INJURY
f-- $
-~ SCHEDULED AUTOS (Per person)
--- -------
~ HIRED AUTOS BODILY INJURY
~ NON-OWNED AUTOS (Per accident) $
- PROPERTY DAMAGE $
(Per aCCident)
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSfUMBRELLA LIABILITY EACH OCCURRENCE $2,000,000
C ~ OCCUR o CLAIMS MADE 01XS13744811 11/07/04 11/07/05 AGGREGATE $2,000,000
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND ITORY LIMITS I IU~~-
EMPLOYERS' . LIABILITY
ANY.PROPRIETORfPARTNERJEXECUTIVE E.L. EACH ACCIDENT $
OFFICERfMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
~~rc:~i~~v~s?6NS below E.L. DISEASE - POLICY LIMIT $
OTHER
) Professional Liab LP7739054 11/0.,/04 11/07/05 Incident $1,000,000
Aggregate $3,000,000
:5CRIPTIONOF OPERATIONS f LOCATIONS f VEHICLES f EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS
7,116 ~~r~tE 15 p~~1:4()
'Ll' .. ~ ..':..,r
:RTIFICATE HOLDER
City of Clearwater
Economic Development &
Housing
112S. Osceola Ave
Clearwater FL 33756
CANCELlATION
CITYCLR 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 LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHOR~EDREPRESENTATIVE
.,..- I --)
1_../- }/ ,f.
@ACORD CORPORATION 1988
:ORD 25 (2001/08)