CERTIFICATE OF INSURANCE (266),his certificate is executed by Liberty Mutual Insurance Group as respects such insurance as is afforded by those companies. BM0068
Certificate of Insurance
This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate is not an insurance policy and does not affirmatively or
negatively amend, extend, or
alter the coverage afforded by the policies listed below. Policy limits are no less than those listed, although policies may include additional sublimity not listed below. Policy limits
may be reduced by claims
or other payments.
This is to certify that (Name and address of Insured)
MALCOLM PIRNIE, INC.
104 CORPORATE PARK DRIVE
WHITE PLAINS, NY 10604
Mutrua?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 subj ect to all their terms,
exclusions and conditions and
is not altered by any requirement, term or condition of any contractor other document with respect to which this certificate may be issued.
Expiration Type
Continuous
Extended
X Policy Term
EfflExp. Date(s) Policy Number(s) Limits of Liability
02/01/2009 102/Ol/2010 WC7-121-092033-019 Coverage afforded under WC law of Employers Liability
the following states: Bodily Injury By Accident
All States Except Monopolistic States $1,000,000 Each Accident
Bodily Injury By Disease
$1,000,000 Policy Limit
Workers Compensation
General Liability
Claims Made
Occurrence
Retro Date
Automobile Liability
Owned
Non-Owned
Hired
Bodily Injury By Disease
$1,000,000 Each Person
General Aggregate-Other than Prod/Completed Operations
Products/Completed Operations Aggregate
Bodily Injury and Property Damage Liability Per
Occurrence
Personal and Advertising Injury Per Person /
Or anization
Other Liability Other Liability
Each Accident -Single Limit - B. I. and P. D. Combined
Each Person
Each Accident or Occurrence
Each Accident or Occurrence
C CANCELLATION DOES NOTAPPLY TONON-PAYMENT OF PREMIUM.
0
M
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N
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IlVIPORTANT 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). ff
SUBROGATION IS WAIVED, subj ect to the forms 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 endorsements.
The following applies only with respect to insurance for motor carriers registered in Florida: As provided for in Fla. Stat. § 320.02(5)(e), the listed insurance policy may not be cancelled
on less than 30 days written notice by the insurer
to the Department of Hwy Safety & Motor Vehicles, such 30 days notice to commence from date notice is received by the Department.
Notice of cancellation: (not applicable unless a number of days is entered below) . Notice of Cancellation does not apply when policy(ies) are canceled due tonon-payment of premium.
Before the stated expiration date the company
will not cancel or reduce the insurance afforded under the above policies until at least 30 days notice of such cancellation has been mailed to the below listed Certificate Holder.
Office : VALLEY STREAM, NY Phone: 516-593-8200
Certificate Holder:
City Clerk
City of Clearwater
P.O. Box 4748
Clearwater, FL 33758
?a.y r. Y .
LYNN HASTEADT
Authorized Rearesentative
Date Issued: 01/22/2009 Prepared By: DG