CERTIFICATE OF LIABILITY INSURANCE (16)
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-05/17/2008 12:54
7274459147
SANDBERGEN
PAGE 01/01
AC.OBQM CERTIFICATE OF LIABILITY INSURANCE I DATI: (MM/DDIYYYY)
06/17/2008
PFlODUCl!;R (727)442-0012 FAX (727)446-9147 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Sandbergen Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
2121 N.E. Coachman Rd. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Clearwater, FL 33765~2616 ALTER THE COVERAGE AFFORDlfD BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC#
INSURI!!Il Patrlc1a " Thomas WolkOINSl<)' 1/llSlJI'lERII:. Granada Insurance Co.
2S Caus~wa)' Blvd INSuRER s:
Suite 4 INSUReR c;
Clearwater Beach. FL B767~2000 INSUAeA ~
lNSuAEFl E:
CO\lEAA(.:J;~
THE POLICIES OF INSuRANCE 1,ISTEO BIilOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY peFUOD INDICATED, NOTINITMS'tANDING
A~ FtEQUIREMENT, TERM OR CONDITION OF AN'( CONiRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ceRTIFICATE MAY BE ISSUeD OR
MAY PERTAIN. THE INSURANCE AFFORDED BY THE: POLICIES DESCRIBED HEReIN IS SUBJ~CT TO ALL THe: TERMS, EXCLUSIONS AND CONDITIONS or: SUCH
POLICIES. AGGRE;:GATE LIMITS SHOWN MAY HAVE BEEN RalUCED E1V PAID CLAIMS.
1/Il.1Jl ~"'i.1 TVPI!i OF INSURANCE POUCY ~ER I'OUCY EI'fECTlVE POLICY EXPII\ATlON ~IMIT$
GENERA~ lIA111~ITV 0185FLOOOO94'8 06/07/2008 06/07/2009 eACH OCCURRENCE ~ 1 000.00(:
P--
. X COMMeRCIAJ. GENEAAL L1AB1~lTY DAMAGE TO RENTI;O $ 100 , OO(]
-
_ ~ CUlIMS MAllE [!J OCCUR MED EXP (My QMq p~~,") $ 50,000
A X PERSONAl. & ArN INJURY $ 1,000
-
GENl:RA~ AGGAEGI\'TE $ 1,000,000
-
GeN'L AGGREGATE LIMIT 1\PI'UES I'ER~ PROOUCTS-COM~PAGG $ 1,000,000
in!,RO- nl
POlICY JECT LOC
AUTOMoetl.~ LIABILITY COMBINED $ING~1i LIMIT
--- (lOA ~l;"Q~ll $
AtffAUTO
-
ALL OWNED AUTOS BOOILY INJURY
--- (Per pMSllfl) S
SCHeOULEO AUTOS
---
HIRED AUTOS BeDIL Y INJURY
- (PIiIr ,;ddenl) $
NON-OWNED AUTOS
-
pROPERTY DAMAGE $
(Per SCClllellt)
i,"jARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
RANY AUTO -- ~n OTHER TJoIAN I;AACC $
wl-r :"'1\ AUTO ONLY; AGQ $
EXCESS/UMBRELLA IJABIUTY EACH OCCURRENCE $
I=t OCCUR 0 ClAIt.t$ MAOe JUN 1 g 2 08 AGGREGATE s
$
R DF.DUCTIElI.E )5 AND $
RETENTION $ OF fCIAL RECOR $
WORKERS COMPENSATION ANIl .~ I we STATU- I IOJ.l;I.
I!MPLOYER$' LIABIt.IT'Y' E.L EACH ACClDIiNT S
ANY PROPFlIETORJPARTNIiRleXECUTIIIE
OFFICEiR/MeMBeR EiXCLUDED? e,L. DISEASE - EA eMPlOYEE $
" ~es. de!c~be uftd~r E.L. DISEASE. POLICY LIMIT ~
S eCIAl. pROVISIONS below
0.'""101\ L' bOlo 0185FLOOOO9498 06/07/2008 06/07/2009 Aggregate Limit $500,000
A ,quor ,a.. It)' Each Common CaU$@ $500,000
DESClVPTION OF OPERATIONS I LOCAllONS /VEHICU!S I EXeI.USIOIolS ADDED BY ENDORSEMENT f SPECIAL PItOVISION&
he Certificate Holder is listed as Additional Insured
City of Clearwat@r
25 Causeway Blvd
Clearwater, Fl 11767
SHOUU) ANY OF 1'11: ABOvE DESCRIBED POUClES 8l! CANCELLED BEFOftE tHE
EXPIFlATlON DATE THI!MOI'. M 1S$U1NG IJll$UREFt Wl\.1. ENDeAVOR TO MAIL
.JJL. aAYS.WFlITTI!N NOTICE TO THI! CI!iRTlFlCATE HOLDER NAMED TO 1\oIE LEFT,
BUT FAlLUFlE TO MAIL SUCH NOT1CI!; SHALL IMPO~E NO 08I.JGATlON OR LIABILITY
OJ' Nrf KI OR RePRESENTATIVES.
AInMO
@ACORDCORPORATION 1988
ACORD 25(2001/08)