CERTIFICATE OF LIABILITY INSURANCE (72)
..
:~ A CORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYI
,j , 2/27/08
PRODUCER 727-796-6666 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wells Fargo Insurance Services ONLY AND CONFERS NO RIGHTS UPON. THE CERTIFICATE
Southeast, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 31666
Tampa, FL 33631-3666 INSURERS AFFORDING COVERAGE
INSURED Cumbey & Fair, Inc. INSURER A: Florida Retail Federation SIF .
2463 Enterprise Road INSURER B: .
Clearwater FL 33763 INSURER c: .. ..
INSURER D: .
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 REOUIREMENT, 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 OFSUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE PRk!fNf,x!~~JJ$~ LIMITS
LTR DATE
GENERAL LIABILITY EACH OCCURRENCE $
I--
COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone firel $
I CLAIMS MADE D OCCUR . MED EXP (Anyone personl $
I-- PERSONAL & ADV INJURY $
GENERAL AGGREGATE $ .
I--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
I POLICY n P~PT n LOC . .
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $
ANY AUTO (Ea accidentl
-
- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS IPer person)
-
HIRED AUTOS BODILY INJURY
- $
NONcOWNED AUTOS {Per accidentl
-
.. .. PROPERTY DAMAGE
- $
(Per accldentl
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
=j ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
A WORKERS COMPENSATION AND 52024651000 3/16/08 3/16/09 1 wc STATU-l IOTH-
! X TORY LIMITS ER
~II/IPLOYERS' L11l.BILlTY I .--
E.L. EACH ACCIDENT $ 1000000
E.L. DISEASE - EA EMPLOYEE $ 1000000
. E.L. DISEASE - POLICY LIMIT $ 1000000
OTHER
DESCRIPTION OF OPERATtONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
FL STATUTE MANDATES 10 DAYS CANC NOTICE FOR NONPAYMENT OF PREMIUM.
CERTIFICATE HOLDER I I ADDITIONAL INSURED: INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF CLEARWATER DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
I V - -.- . NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL
PO BOX 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
CLEARWATER FL 33758-4748 REPRESEIltMtTIVES. J J .
AUTH~EPRESENT~ ___ Y
I ~.~/ ..........v
ACORD 25-S (7/97)
46- 38
@) ACORD CORPORATION. 1988
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IMPORT ANT
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-S (7/97)