CERTIFICATE OF INSURANCE (246)
A CQ-.RDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY)
11/09/04
PRO{l.UCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
BB& Tiler Wall & Shonter ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
800 49th Street North HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 14448
St Petersburg, FL 33733 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: FCCI Commercial Insurance Company 33472
Climate Design Air Cond.lnc. INSURER B: Ohio Casualty Insurance Company 24074
12530 47th Way North INSURER C: Bridgefield Employers Insurance 10701
Clearwater, FL 33762 INSURER D:
INSURER E:
Client#. 902793
69CLlMADES
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,
LTR NSRI TYPE OF INSURANCE POLICY NUMBER PD~{~1r9~~68mIE Pg~fl (~'g;~~N LIMITS
A GENERAL LIABILITY BINDER4299825 11/08/04 11/08/05 EACH OCCURRENCE $1 000.000
'-- DAMAf3E JO RENTED nM'
X COMMERCIAL GENERAL LIABILITY $100.000
1 CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $5 000
X PO Ded:500 PERSONAL & ADV INJURY $1 000.000
GENERAL AGGREGATE $2 000.000
-
~'L AGGRn LIMIT APnS PER: PRODUCTS - COMP/OP AGG $2.000 000
POLICY rr8i LOC
A AUTOMOBILE LIABILITY BINDER4299825 11/08/04 11/08/05 COMBINED SINGLE LIMIT
- $1,000,000
..!.. ANY AUTO , (Ea accident)
..!.. ALL OWNED AUTOS BODILY INJURY
$
,!... SCHEDULED AUTOS (Per person)
,!... HIRED AUTOS BODILY INJURY
$
X NON-OWNED AUTOS (Per accident)
f---
I-- PROPERTY DAMAGE $
(Per accident)
RRAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
B ~ESS/UMBRELLA LIABILITY BX00453021659 11/08/04 11/08/05 EACH OCCURRENCE $2 000 000
X OCCUR D CLAIMS MADE AGGREGATE $2 000 000
$
~ DEDUCTIBLE $
X RETENTION $0 $
C WORKERS COMPENSATION AND 0830242190000 01101/04 01/01/05 I T'f!.~VS(~~;", I TOJ~-
EMPLOYERS' LIABILITY '. -E.L. EACH ACCIDENT l1,000..000
- ".,-, ~>........ -'. ........~.'. ....' '-. .' --.", ---,-- ~ ~ --- -.-..----,----,;--; .. ----. -:' ..
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E,L DISEASE - EA EMPLOYEE $1,000,000
If yes, describe under E,L DISEASE - POLICY LIMIT $1,000,000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Broad Form Additionallnsd.Endt.incl.on GL
CERTIFICATE HOLDER
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 -10.... DAYS WRITTEN
POBOX 4748 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
CLEARWATER, FL 34618 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES,
A<TI::f;:~~
ACORD 25 (2001/08) 1 of 2
#M1345739
MACA
@ ACORD CORPORATION 1988