CERTIFICATE OF INSURANCE (234)
ACORD.
CERTIFICATE OF LIABILITY INSURANCE
OP 10 DATE (MMlDDNYVY)
ROLYN-1 10/27/04
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
Horenberg Insurance Serv Inc
10770 Columbia Pike #201
Silver spring MD 20901
Phone:301-628-4000 Fax:301-628-4001
Rolyn Construction corporation
5706 Frederick Avenue
Rockville MD 20852
INSURERS AFFORDING COVERAGE
IN::iURER A Twin City Fire Ins. CO.
INSURER B_~~~~eral Insuranc~ Company
INSURERC American International
INSURERD Crum & Forster Spec Ins
INSURERE Evanston Insurance C an
NAIC#
29459
20281
INSURED
COVERAGES
35378
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEr, ISSUED TO THE INSURED tJAMED ABOVE FOR THE POLlCl PERIOD INDICATED, NOTWITHSTANDIW,
ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCl.IMEI,T WITH RfSPECT TO WHICH THIS r~ERTIFICATE MAY r;E ISSUED OR
MAY F'ERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUB,IECT TO ALL THE TERMS, EXCLUSIONS AND CON['ITIOt~S OF SUCH
POLICIES A,GGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCEI' BY PAID CI.A,IMS
LTR NSR[ TYPE OF INSURANCE POLICY NUMBER DA"rE (MMlDDIYY) "DATE' (MMlDDIYY) LIMITS
GENERAL LIABILITY EACH OCCUr!RENCE $ 1000000
f---- . 1~,1~~J.193. __1,~l :g/.o! ~ .~
D X CC'MMERCIAL GENERAL LIABILITY GLO 011045 ~?E0lSa Q(;_~.urE'nce)..:-_ $ 50000
- ------ -, -'---=,..... UCLAI'Ms MADE~ ~Joc~u~ ----"-"" '-____,___~_______...o_::: ___'____ T ~, .
MED EXP (Anyone person) $
r-----
PEr~SONAL & ADV INJUF.: ,( $ 1000000
r-----
GENERAL AGGREGATE $5000000
f- I
GEN'L AGe_REGATE I.IMIT APPI.IES PEP PRODUCT.S - COMPJOP AGG $ 1000000
n p'L1'Y n PRO, nLe'c
U I" ,IECT I
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
-. (Ea accident) $
ANY AUTO
r-----
ALL OWNED AUTOS BOI'II. Y IN,IURY
r----- (Per person) $
SCHEDULED AUTOS
f----
HIRED ,^,UTO::; BODIL Y INJURY
r----- $
NON-OWNE[' AUTO~i {Per acr::identl
f-
r----- PROPERTY DAMAGE $
(Per ar;Cldenl)
GARAGE LIABILITY AUTO ()NL,( . EA ACCIDEt~T $
R ANY p,JJro OTHER THAN EA ACC $
AUTO ONI Y .A.GC-, $
EXCESS/UMBRELLA LIABILITY fCACH OCCURRENCE $ 5000000
E ~ OCCUR D CLAIMS MADE XO-NJ-1830-03 12/31/03 12/31/04 AGGRE (oil TE $ 5000000
-,~---,----- $
---------"-- ---" ---~~---~~-
R DEDUCTI8LE $
~-
RETENTION $ $
WORKERS COMPENSATION AND X IT~YL:~Ws I J~~fi
Efl. I-~
A ',LIAB1LITY_ 42WEKJ~' 12"'/3110r -T2]'3I704 n eACH ACCIDENI -$ 50lroOll .-.-
ANY PROPRIETORIPARTNER/EXE':UTIVE
OFFICER/MEMBER EXCLUDED? EL DISEASE, EA EMPLOYEE $ 500000
If ves, Ijes'.::nbe under POLICY LIMIT $ 500000
SPECIAL PROVISIONS below E L DISEASE,
OTHER
B Equipment Floater 0662-34-64 DCO 12/31/03 12/31/04 special $679,954
C Pollution Liabilit CPL4763312 02/12/03 02/12/04 OCC/Agg $1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Verification of Insurance
CERTIFICATE HOLDER
CANCELLATION
CITYCLE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10
DAYS WRITTEN
city of Clearwater
112 S. Osceola Ave.
Clearwater FL
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHOR. PRESE~I,/VE.<," ./'.
" 4.......~?/~~
ACORD 25 (2001/08)
@ACORD CORPORATION 1988