CERTIFICATE OF LIABILITY INSURANCE (5)
i'
PRODUCER (407) 886- 3301
FAX (407)886-9530
DATE (MMlDDIYYYY)
10/27/2003
THIS CERTIFI ATE 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.
ACORD
TM
CERTIFICATE OF LIABILITY INSURANCE
GENTRY INSURANCE AGENCY
POBox 2046
Apopka Fl 32704-2046
INSURED
INC
INSURERS AFFORDING COVERAGE
NAIC#
Clark Sales Display,
POBox 1007
Tavares Fl 32778
Inc.
INSURER A: Valley Forge Insurance CO
INSURER B: Tran sporta t i on In su rance CO
INSURER C:
INSURER 0:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN
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,
LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE./IiIlMlD~ DATE IMMlDDNYI LIMITS
GENERAL LIABILITY BAPP2072710292 08/01/2003 08/01/2004 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY ~REGlS~s lEa occurence I $ 100,000
I CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $ 5,000
A X PERSONAL & ADV INJURY $ 1,000,000
I-- GENERAL AGGREGATE $
2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000
Xl .n PRO- nLOC
X POLICY JECT
AUTOMOBILE LIABILITY B2072119475 10/25/2003 08/01/2004 COMBINED SINGLE LIMIT
- (Ea accident) $
X ANY AUTO 1,000,000
-
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AUTOS
B -
X HIRED AUTOS BODILY INJURY
- (Per accident) $
X NON-OWNED AUTOS
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
=l ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY BAPP2072710292 08/01/2003 08/01/2004 EACH OCCURRENCE $ 2,000,000
TI OCCUR o CLAIMS MADE AGGREGATE $ 2,000,000
A X Umbrella Form $
;j DEDUCTIBLE $
X RETENTION $ 10,000 $
WORKERS COMPENSATION AND -I TORY LIMITS I IUER-
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYE $
If yes, describe under E.L. DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER B2072119475 10/25/2003 08/01/2004 Comprehensive Deductible $ 100
~ired Auto Physical
B pamage Collision Deductible $ 250
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
~E: Holiday Decorating Services
ity of Clearwater is included as Additional Insured on General Liability and Auto liability.
- 'r: D
~~( .....VI:L
CERTIFICATE HOLDER
CANCELLATION
City of Clearwater
Attn: Debbie Reid
PO Box 4748
Clearwater, Fl 33758-4748
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
OFFIC -.l..O..- DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
LEGIS IAt RECORDS DBUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
lATIVE 5RVCS D PT OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
NOV 0 7 20D3
Debra liebknecht/IRMA
Q)Jn" rJ it.8k,..-.tk-
ACORD 25 (2001/08) FAX: (727)562-4825
@ACORD CORPORATION 1988