CERTIFICATE OF LIABILITY INSURANCE (4)
ACORDTM
CERTIFICAT.OF LIABILITY INSURAN
DATE (MMlDD/VY)
11/18/1999
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-Tt'.E.COVE-RAGE AFFOnCEa-BV-THe-POt:ICtES.BELOW.- -.
E
PRODUCER
MITCHELL AGENCY INC
14290 WALSINGHAM RD
LARGO
727-595:'2529
I
n _:43.71.4..
INSURERS AFFORDING COVERAGE
INSURED
Pickels Plus Too. Inc.
320 Cleveland Street
Clearwater FL 33759
INSURER A: National Gra e Mutual Insurance C an
INSURER B:
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. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDmON 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.
I~i': TYPE OF INSURANCE POLICY NUMBER ~I,LCV EfFECnvE POLICY EXPIRATION LIMITS
~NERAl LIABILITY EACH OCCURRENCE $ 500.000
~ COMMERCIAL GENERAL UABIUTY FIRE DAMAGE (Anyone fire) $ 50.000
~. CU\lMS MADE W OCCUR MED EXP (Anyone person) $ 5.000
A BPG15254 04/24/1999 04/24/2000 PERSONAL & ADV INJURY $ 1.000.000
~n1E "M" """"'''''' I GENERAL AGGAEGA TE $ 1 000.000
PRODUCTS. COMPIOP AGG $ 1.000.000
POUCY ~~ n LOC
~TOMOBILE LIABILITY COMBINED SINGLE UMIT $
ANY AUTO (Ea accident)
-
- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
-
- HIRED AUTOS BODILY INJURY
(Per accident) $
- NON-DWNED AUTOS
- PROPERlY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
~ESS LIABILITY EACH OCCURRENCE $
OCCUR 0 CU\lMS MADE AGGAEGA TE $
$
=J DEDUCTIBLE '" $
RETENTION $ ~ $
WORKERS COMPENSATION AND I we STATD.
TORY liMIT!': I
EMPLOYERS' LIABILITY E.L EACH ACCIDENT $
E.L DISEASE. EA EMPLOYEI .!i____
_.. ,..-.', -.--.- .._-,- -- - -- - ",.,. -- "... -.-.-- "-.. .-." --- -.-- ~ - - .-..."
E.L DISEASE. POUCV UMIT $ .
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
!
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
City of Clearwater - Libra~ SHOULDANVOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
100 North Osceola Avenue DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -L DAYS WRITTEN
Clearwater FL 33775 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Attn: Holly ,""'"".. OOU")l"'" "" w'","'"0' ""'.... """" ,..... nR...... O.
"""""'"........ . ~ ~ I ~ . ~
AUTHORIZED REPR~E ff' 7J./.
I '...- I' - I I.
~- ... -...
ACORD 25-S [1/97)
@ACORDCORPORATION 1988