CERTIFICATE OF LIABILITY INSURANCE (6)
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CERTIFICATE OF LIABILITY INSURANCE
FAX (407)886-9530
INC.
DATE (MMlDDNYVY)
07/22/2004
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 (407)886-3301
GENTRY INSURANCE AGENCY,
2121 E. SEMORAN BLVD.
P. O. BOX 2046
APOPKA, Fl 32704-2046
INSURED C ar Sa es D1 sp ay, Inc.
POBox 1007
Tavares, Fl 32778
INSURERS AFFORDING COVERAGE
INSURER A: Valley Forge Insurance Co.
INSURER B: Transportati on Insurance Co.
INSURER c:
INSURER D:
INSURER E:
NAIC#
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,
I~~: ~o..~~ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY 2072710292 08/01/2004 08/01/2005 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000
I CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $ 10,000
A X PERSONAL & ADV INJURY $ 1,000,000
- GENERAL AGGREGATE $ 2,000,000
- 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
Xl n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY B2072119475 08/01/2004 08/01/2005 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
X (Per accident) $
NON-OWNED AUTOS
-
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY 2072710292 08/01/2004 08/01/2005 EACH OCCURRENCE $ 2,000,000
:KJ OCCUR o CLAIMS MADE AGGREGATE $ 2,000,000
A X $
~ DEDUCTIBLE $
X RETENTION $ 10,000 $
WORKERS COMPENSATION AND I T"X~~T ~J~~ I IOJ~-
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
-- "MV PP('\PPI<=T('\P/P"RTNFR/FXFClJTIVE ---- -- ----~--------~--- -_..----------------- i----~
OFFICER/MEMBER EXCLUDED? E.L. DISEASE: EA EMPLOYEE $
~~~MLs~~~v~~1c3~s below E.L. DISEASE - POLICY LIMIT $
O]HER Physical B2072119475 08/01/2004 08/01/2005 Comprehensive Deductible $ 100
B -rued Auto Collision Deductible $ 250
lamage
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
~E: Holiday Decorating Services
ity of Clearwater is included as Additional Insured on General liabil ity and Auto liability.
~10 days notice allowed for non-payment, 30 days notice allowed for all other reasons.
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
30* 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 INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Q).fn" d~~-.tk:-
Debra liebknecht/IRMA
ACORD 25 (2001/08) FAX: (727)562-4825
@ACORDCORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
~--- - ---1------
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001/08)