Group Title: Historic St. Augustine: Block 7 - Lot 3
Title: Certificate of liability insurance
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Full Citation
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Permanent Link: http://ufdc.ufl.edu/UF00090507/00028
 Material Information
Title: Certificate of liability insurance
Series Title: Historic St. Augustine: Block 7 - Lot 3
Physical Description: Financial/tax record
Language: English
Publication Date: 2001
 Subjects
Subject: Saint Augustine (Fla.)
35 Saint George Street (Saint Augustine, Fla.)
Gonzalez House (Saint Augustine, Fla.)
Spatial Coverage: North America -- United States of America -- Florida -- Saint Johns -- Saint Augustine -- 35 Saint George Street
Coordinates: 29.896657 x -81.313269
 Record Information
Bibliographic ID: UF00090507
Volume ID: VID00028
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution.
Resource Identifier: B7-L3

Full Text




ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE 1M
PRODUCER 850-877-8181 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Palmer & Cay of Florida, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
240 North Magnolia Drive COMPANIES AFFORDING COVERAGE
Tallahassee, FL 32302-0749 COMPANY
A TIG Insurance Company
INSURED COMPANY
Florida Pest Control & B Hartford Underwriters Ins. Co.
Chemical Co COMPANY
P.O. Box 5369 C
Gainesville FL 32602 COMPANY
I D
COVERAGES
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 POLICY EFFECTIVE PULICY EXPIRATION
C TYPE OF INSURANCE POLICY NUMBER DT N LIMITS
LTR DATE (MM/DDfYY} DATE (MM/DD/Y)

A GENERAL LIABILITY T638860337 3/01/01 3/01/02 GENERAL AGGREGATE $ 2000000
X COMMERCIAL GENERAL LIABILITY PRODUCTS COMP/OP AGG $ 2000000
CLAIMS MADE | OCCUR PERSONAL & ADV INJURY $ 1000000
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 1000000
FIRE DAMAGE (Any one fire) $ 50000
MED EXP (Any one person) $
A AUTOMOBILE LIABILITY CA38860338 3/01/01 3/01/02 COMBINED SINGLE LIMIT $
X ANY AUTO 1000000
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person)
X HIRED AUTOS BODILY INJURY
X NON-OWNED AUTOS (Per accident)

PROPERTY DAMAGE $

GARAGE LIABILITY AUTO ONLY EA ACCIDENT $
ANY AUTO OTHER THPrJ -.' LT:'r .,Tri. _
EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM _
I WC STATU- I H
B WORKERSCOMPENSATION AND 21WNMS3901 3/01/01 3/01/02 X STORY LIMITS E
EMPLOYERS' LIABILITY EL EACH ACCIDENT $ 500000
THE PROPRIETOR/ INCL EL DISEASE POLICY LIMIT $ 500000
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL EL DISEASE EA EMPLOYEE $ 500000
A OTHER T638860337 3/01/01 3/01/02
WDO INSPECTION $100,000 PER CLAIM
PROFESSIONAL $300,000 AGGREGATE
LIABILITY
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS





CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CITY OF ST. AUGUSTINE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL

48 KING STREET 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
ST. AUGUSTINE, FL 32084 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGNTS OR REPRESENTATIVES.
AUTH ED REPRESENT IVE


ACORD 25-S (1/95) 21- 7 0ACORD CORPORATION 1988








PALMER & CAY
Established 1868
Insurance Agents & Brokers Employee Benefit Consultants
240 North Magnolia Drive (32301) P.O. Box 749 Tallahassee, FL 32302-0749
Telephone (850) 877-8181 Fax (850) 942-4928

Our records indicate your company requires an annual Certificate of Insurance for
Florida Pest Control and Chemical Company. If you no longer wish to receive a
certificate, please complete the form below and return to our office so we can
remove you from our records. If a return response is not received you will continue
to receive certificates annually. Mail or fax the form to the address below:

Palmer & Cay of Florida, Inc.
Attn: Dawn Wallace
P.O. Box 749
Tallahassee, FL 32302

(850) 942-4928 Fax Number



Your name and address as it appears on the Certificate of Insurance:













Receipt of this completed form will remove the above
certificate holder from our records.

Please feel free to contact Dawn Wallace at Palmer & Cay (850-877-8181, extension 4314)
should you have any questions.




Member of
( Assurex International Insurance Brokers With Over 80 Offices Worldwide




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