CERTIFICATE OF LIABILITY INSURANCE (2)ACORD.M CERTIFICATE OF LIABILITY INSURANCE OPID JB DATE (MM/DD/YYYY)
BELLO-1 11/11/08
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Lykes Insurance, Inc. - WP HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. O. Box 2703
Winter Park FL 32790
Phone:407-644-5722 Fax:407-628-1363
INSURED
Bellomo Herbert & Company Inc.
Orl801 Suite 730
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: Old Dominion Insurance. Co. 4 0 2 31
INSURER B: National Casualty Co.
INSURER C:
INSURER D:
INSURER E:
%IVVERAGES
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.
IRS
LT R71 DDSR
IRATION
D/Y)
TYPE OF INSURANCE POLICY NUMBER DATEYMM/DD/YY E PDATE MM/D
LIMITS
GENERAL LIABILITY EACH OCCURRENCE
-
- S 1,000, 000
---
A XLOMMERCIAL GENERAL LIABILITY 2 5- BHO OO - 1 10/23/08 10 / 2 3/ 0 9 TURENTEU
AMAGE
PREMISES (Ea occurence) $ l O O, 0 0 0
J CLAIMS MADE OCCUR MED EXP (Any one person)
-- $ 5, 000
-
--
PERSONAL & ADV INJURY $ 1 , O O O , O O
0
I GENERAL AGGREGATE $ 2, 0 0 0, 0 0 0
EN'L AGGREGATE LIMIT APPLIES PER:
GEN-L AGGREGATE LIMIT APPLIES PE
PRODUCTS • COMP/OP AGG.
O O O, O O O
POLICY PRO LOC
JECT
OMOBILE LIABILITY
AUT
COMBINED SINGLE LIMIT
$ 1, 0 0 0, 000
A ANY AUTO 25-BH000-1 10/23/08 10/23/09 (Ea accident)
ALL OWNED AUTOS
S r-' /_ _
E-
1 - BODILY INJURY
(Per person) $
AUTO
SCHEDULED
_- 1
,
rX HIRED AUTOS BODILY INJURY $
r -J
X NON-OWNED AUTOS t/ I t? 008
1 Y 3 (Per accident)
-----------
-----
-
PROPERTY DAMAGE
$
GLAL (Per accident)
GARAGE LIABILITY LS ISLATIVE SRV S DEPT
AUTO ONLY - EA ACCIDENT $
ANY AUTO
A N EA ACC
OTHER S
F ONLY
AUTO
AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 2, 0 0 0, 0 0 0
A X OCCUR CLAIMS MADE i 25-BH000-1 10/23/08 10/23/09 AGGREGATE s2,000,000
DEDUCTIBLE $
X RETENTION $10,000
. -
$
--- ..... - ------ --.__. - --------- --- `-r -- _._ __-_. ------ -- -- - ---------- -- -------- -
WORKERS COMPENSATION AND 1 - ..
TORY LIMITS 1-_ E _
A EMPLOYERS' LIABILITY WC-BH00O-1 10/23/08 10/23/09 EL EACH ACCIDENT $ 500, 000
-
ANY PROPRIETOR/PARTNER/EXECUTIVE - -- -
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 5 O O , O O O
If yes, describe under
E.L. DISEASE • POLICY LIMIT
$ 5 0 0 , O 0 O
SPECIAL PROVISIONS below
OTHER
B Professional AR00002777 05/13/08 05/13/09 1 Per Claim 1,000,000
Liability Aggregate 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
lrCR11f IVA1G nvL.V Grp ------_- _ _
CITY10 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Clearwater IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
112 South Osceola Ave
FL 33756 REPRESENTATIVES.
Clearwater NTATIVE
AUTH R
{
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n w??e?e?l. /.111111 I?TIl1I.1 A,f00
ACORD 25 (2001/08)
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
I-- - -- --- DISCLAIMER _--
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
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