CERTIFICATE OF LIABILITY INSURANCE
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYY)
07/02/2001
PRODUCER (407)886-3301 FAX (407)886-9530 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
GENTRY INSURANCE AGENCY, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
2121 E. SEMORAN BLVD. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. O. BOX 2046
APOPKA, FL 32704-2046 INSURERS AFFORDING COVERAGE
INSURED Clark Sales Dlsplay Inc INSURER A: Republic Western Ins Co
PO Box 1007 INSURER B: Auto-Owners InsCo ,
Tavares, FL 32778 INSURER c:
INSURER 0:
I INSURER E:
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.
I~f~ TYPE OF INSURANCE POLICY NUMBER POLICY EFFggmr- Pgilfl'~:'bR':~~N LIMITS
GENERAL LIABILITY MPOO02432 08/01/2000 08/01/2001 EACH OCCURRENCE $ 1,000,000
f-,-
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ 50,000
I CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $ 1,000
A PERSONAL & ADV INJURY $ 1,000,000
-
GENERAL AGGREGATE $ 2,000,000
- 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
Xl POLICY n ~~8i n LOC
AUTOMOBILE LIABILITY 4253955700 10/25/2000 10/25/2001 COMBINED SINGLE LIMIT
X ANY AUTO (Ea accident) $ 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 LIABILITY ~MCOO02019 08/01/2000 08/01/2001 EACH OCCURRENCE $ 2,000,000
t!J OCCUR D CLAIMS MADE AGGREGATE $ 2,000,000
A $
J, DEDUCTIBLE $
X RETENTION $ 10,OOC $
WORKERS COMPENSATION AND I T~*-r L~~S I 10 -
ER
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
- - -"- - .-- --- -- ._--, - - ~--._-----'------- '--- ---- - - --- -- ELDISEASE.-EA EMRLOYEl $- --- - ----- .--
E. L. DISEASE - POLICY LIMIT $
OTHER 4253955700 10/25/2000 10/25/2001 Comprehensive Deductible $250
~lred/Non-OWned Auto P
B ~ysical Damage Coverag Collision Deductible $250
-~-"./-
~ESCRIPTION OF OPERATIONSlLOCATIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS nt::
E: Holiday Decorating Services , \,,,.; c. .
ity of Clearwater is included as Additional Insured on General Liability and Auto Liabi~b?'.n : lOW
CITY CLERK D -,
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
City of Clearwater -1!L.. DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Attn: City Clerk BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
PO Box 4748 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
Clearwater, FL 34618-4748 AUTHORIZED REPRESENTATIVE ~,-iJlJJk,.tik-
Debra LiebknechtlDEBRA
ACORD 25-5 (7/97)
@ACORD CORPORATION 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
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 25-5 (7/97)