CERTIFICATE OF LIABILITY INSURANCE
Carlisle Fields & Company, Inc
P.O. Box 7910
Clearwater FL 33758-7910
',A"c6R/J""""'.....eEBilllsli"CI>mi:.~IIBll.lDlmll.IB.mBI........~.SI.......(;~~....It................................ DATE IMM/DDIYYI
~9....~l:{$HL. 01/28/98
PRODUCER 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
Pat A. Carlisle
Phone No. 813-797-0441 Fax No. 813-725-3663
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 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 TEAMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
UR_
TYPE OF INSURANCE
POUCY NUMBER
POUCY EFFECTIVE POUCY EXPIRATION
n I)A TEJIVI1VI1QQlYYI cn,DA TE lNIM/l)DJYYI
UMITS
GENERAL UABIUTY
B X COMMERCIAL GENERAL LIABILITY 20522527
CLAIMS MADE [i] OCCUR
OWNER'S & CONTRACTOR'S PROT
X Products/Compl Op
X Premises& erat.
11/01/97
GENERAL AGGREGATE $ 2, 000, 000
11/01/98 PRODUCTS. COMP/OP AGG $ 1,000,000
PERSONAL & ADV INJURY $ 1,000,000
EACH OCCURRENCE $ 1, 0 0 0 , 000
FIRE DAMAGE (Anyone fire) 5 0 , 000
MED EXP (Anyone pereon) 5 , 0 0 0
AUTOMOBILE UABIUTY
X ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
C X HIRED AUTOS
C X NON-OWNED AUTOS
C
20392278
11/01/97
11/01/98
COMBINED SINGLE LIMIT
$500,000
BODILY INJURY
(Per peroon)
BODILY INJURY
(POI accident)
PROPERTY DAMAGE
GARAGE LlABIUTY
ANY AUTO
AUTO ONLY. EA ACCIDENT $
OTHER THAN AUTO ONLY:
EACH ACCIDENT
AGGREGATE
EACH OCCURRENCE
EXCESS UABIUTY
C X UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATI!)NAND
BIIIPLOYERS' UABIUTY
A THE PROPRIETOR!
PARTNERSIEXECUTIVE
OFFICERS ARE:
OTHER
INCL 407837401
X EXCL
01/01/98
01/01/99 EL DISEASE - POLICY LIMIT
EL DISEASE - EA EMPLOYEE
$1,000,000
$1,000,000
.
20393610
11/01/97
11/01/98 AGGREGATE
DESCRIPTION OF OPERATIONS/LOCATIONSNEHlCLES/SPECIAL ITEMS
Liability polt'cy also extends coverage for Independent Contractors and
Contr~ctual Lability.
The City of Clearwater, a municipal corporation, is named as Additional
Insured.
PROJECT: TENANT BUILD-OUT AT HARBORVIEW CENTER: PICKLES PLUS DELI TOO
CITYOFC
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES 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 OBUGATION OR UABIUTY
City of Clearwater
ATT: HOLLY
112 S. Osceola Ave
Clearwater FL 33765
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