CERTIFICATE OF LIABILITY INSURANCE (12)
~ . CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY)
ACORDN OP 10 011 03/05/08
PICKL1
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Bouchard-Clearwater ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
101 Starcrest Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
POBox 6090 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater FL 33758-6090
Phone: 727-447-6481 Fax:727-449-1267 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Phoenix Insurance Company
INSURER B:
Pickles Plus Inc INSURER C:
Kim Benedettini Blazakis
PO Box 148 INSURER D:
Fox River Grove IL 60021
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.
IN"", ~~~ POLICY NUMBER ~~'1!~1MM/DDrril- '8k~GEYIMMJDDIYYT LIMITS
LTR TYPE OF INSURANCE
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
- Uf\JW\<>~ ru:"'~N I ~u
A X COMMERCIAL GENERAL LIABILITY I6804638A922PHX08 03/23/08 03/23/09 PREMISES (Ea occurence) $ 300000
I CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $ 5000
PERSONAL & ADVINJURY $ 1000000
f-----
GENERAL AGGREGATE $ 2000000
f-----
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG $ 2000000
Xl POLICY n ~f~T n LOC LIQ LIAB 1000000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $
ANY AUTO (Ea accident)
~
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
HIRED AUTOS BODILY INJURY
- $
NON-OWNED AUTOS (Per accident)
-
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
=1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AGGREGATE $
$
=1 DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I TORY LIMITS I IUJ~-
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $
OFFICERlMEMBER EXCLUOED? E.L DISEASE - EA EMPLOYEE $
If yes, describe under E.L DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES J EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
FAX: 727-562-4825 -- re: location at 320 Cleveland st., Clearwater, FL
CERTIFICATE HOLDER
CANCELLATION
CITCLEA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
CITY OF CLEARWATER
ATTN: MARK GOHEEN
100 SOUTH MYRTLE AVE
CLEARWATER FL 33756
@ACORDCORPORATION 1988
ACORD 25 (2001/08)