CERTIFICATE OF INSURANCE (225)
Certificate of Insurance
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT AN
INSURANCE POLICY AND DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW.
This is to Certify that
I TWEAN SUBSIDIARY, LLC
2530 DREW STREET
CLEARWATER, FL 34625
I
Name and
~- address of
Insured.
'*.~ Libertx
.\Pl MutualTM
L ~
Is, at the issue date of this certificate, insured by the Company under the policy(ies) listed below, The insurance afforded by the listed policy(ies) is subject to all their terms, exclusions
and conditions and is not altered by any requirement, term or condition of any contract or other document with respect to which this certificate may be issued,
EXP.DATE
* D CONTINUOUS
TYPE OF POLICY D EXTENDED POLICY NUMBER LIMIT OF LIABILITY
~ POLICY TERM
WORKERS COVERAGE AFFORDED UNDER WC EMPLOYERS LIABILITY
COMPENSATION LAW OF THE FOllOWING STATES: Bodily Injury By Accident
01/01/2003 WA2-62D-004762-013 Each
10 1,000,000 Accident
01/01/2004 Bodily Injury By Disease
- ---. 1,000;000 Policy
Limit
Bodily Injury By Disease
1,000,000 Each
Person
GENERAL LIABILITY 01/01/2003 RG2-621-004762-023 General Aggregate - Other than Products/Completed Operations
10 4,000,000
D 01/01/2004 Products/Completed Q:>erations Aggregate
CLAIMS MADE
2,000,000
!"ETRO OATE I Bodily Injury and Property Damage Liability Per
2,000,000 Occurrence
Per Personl
~ Organization
OCCURRENCE Other IOther
AUTOMOBILE LIABILITY 01/01/2003 AS2-621-004762-033 Each Accident - Single
10 $1,000,000 Limit
01/01/2004 B,I. and P,D, Combined
~ OWNED Each Person
~ NON-OWNED Each Accident or Occurrence
~ HIRED Each Accident or Occurrence
_ OTHER --.---- -.'---'-------~- --- --'-'---- --- .-... ."~--~--- .~ _--__c____ --- -- -- ----- ..- - __._____ -----'--0-_---- . - -- --'. --
ADDITIONAL COMMENTS
CERTIFICATE HOLDER IS INCLUDED AS ADDllIONAL INSURED
. If the certificate expiration date is continuous or extended term, you will be nolified if coverage is terminated or reduced before the certificate expiration date,
SPECIAL NOTICE-OHIO: ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN
APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUlL T'OF INSURANCE FRAUD.
IMPORTANT NOTI:E TO FLORDA POLICYHOLDERS AND CERTFICATE HOLDERS IN THE EVENT YOU HAVE ANY QUESTIONS OR NEED INFORMATION
~g~1 "k~bSH~EH~~~~~ME~'i,'FN~~~~~~~~~~~ TCH~NI~~JO'l?~I~i~f~ff~~~gg~Mg~':.1A~7~~~~~m:ES~~A~~t~b~~Nci'B~~~~5RB~~it~~NT~7i Liberty Mutual Group
NUMBER
NOTICE OF CANCELLATON: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORF THF STATED EXPIRATION DATE THE COMPANY WILL
NOT CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS
c;~(.K~
Eileen Kiniery
AUTHORIZED REPRESENTATIVE
ICJTY OF CLEARWATER
112 SOUTH OSCALAAVE,
CLEARWATER, FL 34616
2021
A-2
CEmRCATE
I-O..l:ER
L
~
New York Office
OFFICE
(212) 391-7500
PHONE NUMBER
1/1/2003
DATE ISSUED
This certificate is executed by LIBERTY MUTUAL GROUP as respects such insurance as is afforded by Those Companies
BS 772L R2