CERTIFICATE OF LIABILITY INSURANCE (3)
ACORDTM
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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 THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
PRODUCER
Carlisle Fields & Company, Inc
P.O. Box 7910
Clearwater FL 33758-7910
Pat A. Carlisle
Phone No, 727 -79 7 - 0441 Fox No, 727 -725 -3663
INSURED
COMPANY
A
Pinnacle Assurance Corp.
COMPANY
B
Owners Insurance Company
Macre Construction, Inc.
& Dan Macre
1231 N. Hercules Ave.
Clearwater FL 34625
COMPANY
C
Auto Owners Insurance Company
COMPANY
D
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN AEDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE IMM/OD/YYI DATE IMM/DD/YYI
GENERAL LIABILITY GENERAL AGGREGATE $2,000,000
B COMMERCIAL GENERAL LIABILITY 20522527 11/01/98 11/01/99 PRODUCTS - COMP/OP AGG $1,000,000
CLAIMS MADE [i] OCCUR PERSONAL & ADV INJURY $1,000,000
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $1,000,000
X Products/Compl Op FIRE DAMAGE (Anyone fire) 50,000
X Premises&O erat. MED EXP IAny one person) 5,000
AUTOMOBILE LIABILITY
11/01/98 11/01/99 COMBINED SINGLE LIMIT $ 500,000
C X ANY AUTO 20392278
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person)
C X HIRED AUTOS BODILY INJURY
C X NON-OWNED AUTOS IPer accident}
PROPERTY DAMAGE
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT
AGGREGATE
EXCESS LIABILITY EACH OCCURRENCE $1,000,000
C X UMBRELLA FORM 20393610 11/01/98 11/01/99 AGGREGATE $1,000,000
OTHER THAN UMBRELLA FORM
WORKERS"COMPENSJITION-AND ----~-_.._,- --_._-~-" -- .,-~_._-,,- ,-.-----,"--
EMPLOYERS' LIABILITY $500,000
A THE PROPRIETOR/ INCL 407837401 01/01/98 01/01/99 EL DISEASE - POLICY LIMIT $500,000
PARTNERS/EXECUTIVE
OFFICERS ARE: X EXCL EL DISEASE - EA EMPLOYEE $500,000
OTHER
DESCRIPTION OF OPERATlONS/LOCATIONSNEHICLES/SPECIAL ITEMS
Liability Policy also extends coverage for Independent Contractors and
Contractual Liability.
The City of Clearwater, a municipal corporation, is named as Additional
Insured.
PROJECT: TENANT BUILD-OUT AT HARBORVIEW CENTER: PICKLES PLUS DELI TOO
.CER.TIFICATE..HOLDER
CITYOFC
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES,
AUTHORIZED REPR
City of Clearwater
ATT: HOLLY
112 S. Osceola Ave
Clearwater FL 33765