CERTIFICATE OF LIABILITY INSURANCE FOR INDEPENDANT CONTRACTORS
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PRODUCER
..........I.l.1liBlllli~lisllRIIRE.....~~.....It/...../.......... DATE (MM/DD/YV1
............>..................:~~..QC~I!::"'l... 0 1/2 8 /98
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
Carlisle Fields & Company, Inc
P,O, Box 7910
Clearwater FL 33758-7910
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
o
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 REDUCED BY PAID CLAIMS,
CO TYPE OF INSURANCE POUCY NUMBER POUCY EFFECTIVE POUCY EXPIRATION UIIIII1'S_._____
!.III._ -- ------.-------...----- DATE lMMIDD/YV1 DATEIMM/DD/YV1
GENERAL UABIUTY GENERAL AGGREGATE $2,000,000
B COMMERCIAL GENERAL LIABILITY 20522527 11/01/97 11/01/98 PRODUCTS. COMP/OP AGG $1,000,000
CLAIMS MADE ~ 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& erat, MED EXP (Anyone pereon) 5,000
AUTOMOBILE UABIUTY $500,000
11/01/97 11/01/98 COMBINED SINGLE LIMIT
C X ANY AUTO 20392278
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per pereon)
C X HIRED AUTOS BODILY INJURY
C X NON-OWNED AUTOS (Per acoident)
PROPERTY DAMAGE
GARAGE UABIUTY AUTO ONLY - EA ACCIDENT
ANY AUTO ,. OTHER THAN AUTO ONLY:
...
EACH ACCIDENT $
AGGREGATE $
EXCESS UABIUTY EACH OCCURRENCE $1,000,000
C X UMBRELLA FORM 20393610 11/01/97 11/01/98 AGGREGATE $1,000,000
OTHER THAN UMBREUA FORM $
WORKERS COIII!PENSATIONAND
EMPLOYERS'. UABIUTY $500000
A THE PROPRIETOR! INCL 407837401 01/01/98 01/01/99 EL DISEASE. POLICY LIMIT $500000
PARTNERS/EXECUTIVE
OFFICERS ARE: X EXCL EL DISEASE - EA EMPLOYEE $ 500000
OTHER
DESCRIPTION OF OPERATlONS/LOCAnoNS/VEHICLD/SPECIAL ITBIIIS
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 HARBORVIBW CENTER: PICKLES PLUS DELI TOO
CITYOFC
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLm BEFORE THE
EXPIRATION DATE TH&!mF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIRCATE HOLD&! NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHAll IMPOSE NO OBUGATION OR UABlUTY
OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES,
AUTHOFlZED
City of Clearwater
ATT: HOLLY
112 S, Osceola Ave
Clearwater FL 33765
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