CERTIFICATE OF LIABILITY INSURANCE (6)
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ACORDTM
CERTIFICATE OF LIABILITY INSURANCE
PRODUCER
MITCHELL AGENCY INC
14290 WALSINGHAM RD
LARGO
727-595~2529
FL
33774
DATE (MM/DD/VV)
09/27/2002
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.
INSURERS AFFORDING COVERAGE
INSURED
Pickles Plus Too Inc.
320 Cleveland Street
Clearwater FL 33758
INSURER A: Old Dominion Insurance Co an
INSURER B:
INSUAER C:
INSURER D:
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 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.
I~i': TYPE OF INSURANCE POLICY NUMBER ~~'!J~~~m'.E Pg~~Y EXPIRATION LIMITS
~NERAL LIABILITY EACH OCCURRENCE $ 500,000
~ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ 50,000
- =:J' CLAIMS MADE W OCCUR MED EXP (Anyone person) $ 5,000
A BPG15254 04/24/2002 04/24/2003 PERSONAL & ADV INJURY $ 500,000
-
GENERAL AGGREGATE $ 1,000,000
-
~'LAGGRnE LIMIT APlS PER: PRODUCTS-COM~OPAGG $ 1,000,000
X POLICY r:;~gT LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
I--
"-- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
"--
I-- HIRED AUTOS BODILY INJURY
(Per accloent) $
"-- NON-OWNED AUTOS
PROPERTY DAMAGE $
(Per accident)
RRAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
rJ' OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I WC STATU- I TOTH-
TOAY LIMITS ER
EMPLOYERS' LIABILITY EL. EACH ACCIDENT $
EL. DISEASE. EA EMPLOYEE $
EL. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATlONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER I X I ADDIT10NAL INSURED; INSURER LETTER: CANCELLATION
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
P.O. Box 4748 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Clearwater FL 33756 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
727-562-4825
Attention: Debbie Reid REPRESENTATIVES.
I AUTHORIZED 'f . rATf'/~J ,Lc~
d
ACORD 25-S 7/9 ~ 7'V 0"" "~~ORD CORPORATION 1988
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