CERTIFICATE OF LIABILITY INSURANCE (7)
ACORQM
CERTIFICATE OF LIABILITY INSURANCE
FAX (407)886-9530
INC.
DATE (MM/DDIYYYY)
08/01/2005
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 ar Sa es D, sp ay Inc
POBox 1007
Tavares, FL 32778
INSURERS AFFORDING COVERAGE
INSURER A Valley Forge Insurance Co./CNA
INSURERB: Trans Continental Insurance Co/C A
NAIC#
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.
INSR 00'1 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY 2072710292 08/01/2005 08/01/2006 EACH OCCURRENCE $ 1,000,00(J
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000
I CLAIMS MADE m OCCUR MED EXP (Any one person) $ 10,000
A X PERSONAL & ADV INJURY $
-
GENERAL AGGREGATE $ 2,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
h nPRO- n
POLICY JECT LOC
AUTOMOBILE LIABILITY 2072119475 08/01/2005 08/01/2006 COMBINED SINGLE LIMIT
~ $
X ANY AUTO (Ea accident) 1,000,00(J
I--
ALL OWNED AUTOS BODILY INJURY
"- (Per person) $
SCHEDULED AUTOS ..
B "X
HIRED AUTOS BODILY INJURY
"X (Per accident) $
NON-OWNED AUTOS
I--
~ PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
tJ OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I T~~T~!~" I IOJ~-
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
If yes, describe under E.L. DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
rRESCRIPTlON 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 Liability and Auto Liability.
~10 days notice allowed for non-payment, 30 days notice allowed for all other reasons.
CERTIFIC
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)Jn", d i.-0k1lL-d:-
Debra Liebknecht/DAWN
ACORD 25 (2001/08) FAX: (727)562-4825
@ACORDCORPORATION 1988