CERTIFICATE OF INSURANCE (239)
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ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
12/01/04
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
BB& Tiler Wall & Shonter ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
800 49th Street North HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 14448
St Petersburg, FL 33733 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Southern Owners Insurance Company 10190
R & R Plumbing & Heating Inc. INSURER B: Auto Owners Insurance Company 18988
Richard L. Redmond INSURER c: Bridgefield Employers Insurance 10701
2876 20th Ave N INSURER D:
St. Petersburg, FL 33713 INSURER E:
Client#. 895045
69RR
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,
LTR NSR" TYPE OF INSURANCE POLICY NUMBER PJ>H~~J~r68.w\E P%~I$.rI~J,=N LIMITS
A ~NERAL LIABILITY 0346122064319203 11/01/04 11/01/05 EACH OCCURRENCE $500 000
~ OMERCIAL GENERAL LIABILITY e~t;1b~~JO RENTED $100,000
f-- CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $10000
JL PD Ded:250 PERSONAL & ADV INJURY $500 000
f-- GENERAL AGGREGATE $1 000 000
n'L AGGREAE LIMIT APnS PER: PRODUCTS - COMP/OP AGG $1,000 000
PRO-
POLICY JECT LOC
B ~TOMOBILE LIABILITY 4166238500 11/01/04 11/01/05 COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $500,000
I--
~ ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
f--
~ HIRED AUTOS BODILY INJURY
$
,!.. NON-oWNED AUTOS (Per accident)
f-- PROPERTY DAMAGE $
(Per accident)
RRAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACe $
AUTO ONLY: AGG $
OESS/UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
C WORKERS COMPENSATION AND 83012165 04101/04 04/01/05 X I WC STATU-, I 10J~-
EMPLOYERS' LIABILITY $100 000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT .
- '-, - - - -
- OFFICER/MEMBER EXCLUDED? '" E.L. DISEASE - EA EMPLOYEE $100,000
If yes, describe under E.L. DISEASE - POLICY LIMIT $500 000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
FLORIDA OPERATIONS ONLY
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ---10...- DAYS WRITTEN
P.O. Box 4748 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Clearwater" FL 34618-4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRE.:.o.~
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ACORD 25 (2001/08) 1 of 2
#M1358866
PKT
@ ACORD CORPORATION 1988