Loading...
CERTIFICATE OF LIABILITY INSURANCE (77)C ty of Clearwater Certificate issued to City of Clearwater 02/04/2009 la in -Liob & Co. 02/04/2009 City of Clearwater City Clerk Po Box 5748 Clearwater, FL 33758 F; Certificate of Insurance Malcolm Pi rni , Inc. Enclosed please find General Li abi 1 i ty Certificate of Insurance evidencing coverage as of 02/01/09 which we trust should suffice your needs. If you have any questions or concerns, please feel free to call our office. Sincerely, lay in Lieb & Co. CC: Anne Marie Coni gl i aro, 1PI /1HI Brittany Brough l , MPI HI UHUT. CERTIFICATE O LIABILITY INSURANCE OZ & /04/2 r 00 1 9 PRODUCER (908)654 -0300 FAX (908)654 -0332 1 api n -- Li eb 200 Sheffield Street Suite 104 Mountainside, NJ 01092 -2314 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO FIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND D ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAID # INSURED Malcolm Pi rn i e , Inc. 104 Corporate Park Drive P. 0. Doc 751 White Plains, NY 10602-0751 INSURER A: Commerce & Industry Ins. Co. 19410 INSURERS, American Intn " l Specialty Lines 26583 INSURER : INSURER D: INSURED E: C0VFRAnFS THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD D INI ICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED O 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. INSI DD' "HYPE OF INSURANCE E POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION I_II�+II'�S GENERAL LIABILITY EACH O CURT ENCE 19000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 190009000 CLAIMS MADE OCCUR MED EXP (Any one person) $ 259000 A GL 1 241 02/01/2009 02/01/2010 PERSONAL a ADV INJURY 190009000 GENERAL AGGREGATE ! 000 M CEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - OOMPIOP AOO t 9 F-] POLICY JE LOO AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ 11000,000 BODILY INJURY {Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON- GINNED AUTO CA 1633242 (ACS) 02/01/2009 0210112010 BODILY INJURY (Per accident) $ A 1633243 MA D 01 009 02/01/2010 PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT OTHER THAN EA CC ANY AUTO $ AUTO ONLY: AGO E DES IUMBRELLA LIABILITY EACH OCCURRENCE $ 20,000,000 FX ODOUR F—� CLAIMS MADE AGGREGATE $ 2090009000 B PROD 1633244 02/01/2009 02/01/2010 DEDUCTIBLE $ RETENTION WORKERS COMPENSATION AND O TATU- I JOTH- TORY LIMITS ER EMPLOYERSP LIABILITY ANY PROP IETOR/PARTNER/E EOUTI E __ E-L_ EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE OFFIOEI IMI=MBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below 1=_L_ DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Re: All Operations of the Named Insured. ...See attached for details... "'Except 10 days premium non-payment. City of Clearwater City Clerk PO Box 5748 Clearwater, FL 33758 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 "_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Richard Rampolla Exec. V. P. wal- A OFD 25 {2001108} OACORD CORPORATION 1988 City of Clearwater Certificate issued to City of Clearwater 02/04/2009 la ire -Lieb & Co. NAMED INSURED: MALCOLM PIFNIE: Endorsements or Modifications as Applicable: General Liability 0001 1207: 1A, 2, 3, 4, 5, Automobile A 9001 10/01: CT, LA, NH, VA): I B , 31 , S, Automobile A 0001 03/06: All Other States) : 1/B, , 4, 5, Excess Liability (71154 08/04): ALL OPERATIONS of THE NAMED INSURED. I A: If required by written contract or agreement, the City of Clearwater, EL is included as additional insured, but only for work performed by the Named Insured per C 2o10 (07104) and CG2037 (07%04) per copies attached. 1/B: If required by written contract or agreement, the City of Clearwater, PL is included as additional insured, per CA 2048 (02/99) per copy attached. : Excludes Professional Liability If required by written contract or agreement, includes Waiver of Subrogation. 4. If required by written contract or agreement, this insurance is primary to the extent coverage is provided by the policy for the Certificate Holder as respects work performed for the Certificate Holder by the Named Insured. 5. If required by written contract or agreement, includes Contractual Liability 6. If required by written contract or agreement, includes Separation of Insureds 7. Policy is follow-form excess of General Liability and Automobile Liability policies except as respects per project and per location aggregate limits. POLICY NUMBER. GL-1633241 COMMERCIAL E E L LIABILITY CG 20 1DD7D THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABUTY COVERAGE PART SCHEDULE Name Of ddi i a l Insured Person(s) Or r L 1 st1 r s: Location f Covered Operations Where required by written contract As required by written contract Information required to complete this Schedule, if not shown above will be shown in the Declarations. A. Section 11 -- Who o I An Insured is amended to B. With h respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional ex lu- or ani ation(s) shown in the Schedule, but only sions apply: with respect to liability for "bodily injury" , "properly danag or "personal and advertising' injury" This insurance does not apply to "bodily in u r '" or ' "property caused, in whole or in part, by. damage after. , Your arts of omissions, or �l . All work, including materials, parts or equip- 2. The ants or omissions of those acting on your ment furnihed in connection with such YVOr}C, on the project (other than service, maintenance behalf, or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional Insured(s) at the location of the the additional insureds at the location(s) de ig- covered operations has been completed. or nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing opera #1 ns for a principal as a part of the same project. CG 20 10 07 04 Q ISO Properties, inc_, 2004 Page I of 1 POLICY NUMBER.- GL1633241 COMMERCIAL GENERAL LIABILITY CG 037X70 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART T SCHEDULE Section II — Who is An insured Is amended to include as an additional Insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for *bodily injurer" or "property damage" caused, in whole or in part, by "your work at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the „produ is o pleted operations hazard ". CG 20 37 07 04 180 Properties, Inc., 2004 POLICY DUMB ER. Ckhw,"1,3242 & CA1633243 COMMERCIAL AUTO CA 20 448 02 9 THIS ENDORSEMENT CHANGES THE POLIO'. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following.- BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement. the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) ) or organization(s) ) who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indi- cated below. Endorsement Effective: 02/0112008 Named insured: Malcolm Purse, Inc. Name of Persons or Organ Mation(s ): Where required by written contract Countersigned B: SCHEDULE Authorized Representative (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsernent -) Each person or organization shown in the Sohcdu #e is an, .insured" for L)abihty Coverage, but only to the extent that person or organization quailifie as an "insured" ender the Who Is An Insured Provision contained in Section It of the Coverage Form- CA 20 48 02 99 Copyright. Insurance Services Office, Inc., 1998 Page 1 of 1 ❑ IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy (ies) rust 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). DISCLAIMS The Certificate of Insurance on the reverse side of this feria does not constitute a contract between the issuing insurers, 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. ACOi D 25 (2001108)