CERTIFICATE OF INSURANCE
ACORDm
CERTIFICATE OF LIABILITY INSURANCE
OP ID DC!I DATE (MM/DDIYYYY)
BELLO 1'1 10/21/04
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.
PRODUCER
SIHLE INSURANCE GROUP, INC.
P. O. BOX 160398
ALTAMONTE SPRINGS FL 32716
Phone:407-869-0962 Fax:407-774-0936
INSURERS AFFORDING COVERAGE
NAIC#
INSURED
BELLOMO-HERBERT./.. INC.
100 E PINE STRE~T STE 204
ORLANDO FL 32801
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
Hartford Insurance
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
L TR INSRIl TYPE OF INSURANCE
GENERAL LIABILITY
-
X
POLICY NUMBER
PD~';l~1ri~J&J!XE Pgk!fEYlij~b~~N
LIMITS
A
COMMERCIAL GENERAL LIABILITY
I CLAIMS MADE [!] OCCUR
21SBABK8880
10/23/03
10/23/04
EACH OCCURRENCE
UAMA\jt: .~
PREMISES (Ea occurence)
MED EXP (Anyone person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS-COM~OPAGG
$1,000,000
$ 500,000
$ 10,000
$ 1,000,000
$2,000,000
$2,000,000
-
10/23/04
10/23/05
-
GEN'L AGGREGATE LIMIT APPLIES PER:
~ nPRO- n
I POLICY JECT LOC
AUTOMOBILE LIABILITY
-
GARAGE LIABILITY
l ANY AUTO
EXCESS/UMBRELLA LIABILITY
!J OCCUR D CLAIMS MAIlE 21SBABK8880
10/23/04
COMBINED SINGLE LIMIT $ 1,000,000
10/23/04 (Ea accident)
10/23/05 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 $ 1,000,000
10/23/05 AGGREGATE $1,000,000
$
$
$
A
ANY AUTO
21SBABK8880
10/23/03
10/23/04
-
-
ALL OWNED AUTOS
SCHEDULED AUTOS
-
~ HIRED AUTOS
X NON-OWNED AUTOS
-
-
A
A
I DEDUCTIBLE
I RETENTION $
WORKERS COMPENSATION AND
~ERS' IIABIIIT'L._.~._~_
ANY PROPRIETOR/PARTNER/EXECUTIVE ~ 1 WECGlf62 8 0
OFFICERlMEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
OTHER
J.UI ",3"1031--- lttt23fO<l
10/23/04 10/23/05
I TORY L1Mm; T X I 0 J~-
c.L: EAC1'fACClOE~-- -$-l,-&e-(}-,-ooe
E.L DISEASE - EA EMPLOYEE $ 1 , 000 , 000
E:L DISEASE - POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
'OA Of' T .n.
q ... I .z5 PH12:04
CERTIFICATE HOLDER CANCELLATION
CITY OF CLEARWATER
112 SOUTH OSCEOLA AVE
CLEARWATER FL 33756
CLEARWl 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.
AU~:P:ES~ ~
, ~'V~ ~
@ACORDCORPORATION 1988
ACORD 25 (2001/08)