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CERTIFICATE OF LIABILITY INSURANCE (79)
M CERTIFICATE OF LIABILITY INSURANCE 101131zo08 PRODUCER (407)628-3441 FAX (888)883-8680 Lassiter-Ware Insurance of Oran ga/Seminole, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Box 940159 Maitland, FL 32794-0159 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: Amerisure Insurance Company 19488 ZMG Construction, Inc. INSURERB: Amerisure Mutual Insurance Co. 23396 477 Commerce Way, Suite #115 INSURERC: Travelers Property & Casualty 36161 Longwood, FL 32750 INSURER D: INSURER E: 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. INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE ( POLICY EXPIRATION LIMITS GENERAL LIABILITY CL2041033020007 1111612007 1111612008 EACH OCCURRENCE $ 11 0001 00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PRFMIqrq (FA ne.,jxPn,..) $ 300,000-- 000;; CLAIMS MADE 7v7 OCCUR OCCUR MED EXP (Any one person) S 101 000%• GENERAL AGGREGATE $ 2, 0001 00 GEN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS - COMP/OP AGG $ 21 0001 00 POLICY X jE o LOC AUT OMOBILE LIABILITY 042041031 1111612007 1111612008 COMBINED SINGLE LIMIT X ANYAUTO (Ea accident) $ 1,000,00 ALL OWNED AUTOS BODILY INJURY B SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 51 0001 00 X OCCUR ? CLAIMS MADE CU2041034 1111612007 0913012008 AGGREGATE $ 51 000, 00 B $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC204103502 1111612007 1111612008 UT_ OTH- X WC A EMPLOYERS' LIABILITY ANY PROP RI ETO R/PARTNER/EXEC UTIVE , E.L. EACH ACCIDENT $ 1,000,00C OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1,000,00C _ .'it-yvs descrih a unaer-.__..-._.:---.-..--_ SPECIAL PROVISIONS below -:..._.,_---_..?_..-_...._. --•-~- -- -_.. - ---•--^? - -?'..' ?E:-C. DISEASE =P01?CYTiM17 -$-""-` I;: 0(33;- I?nland Marine - Limit @ $100,000 C Rented/Leased T-660-6707L771-TIL-07 11/16/2007 1111612008 Deductible @ $1,000 E ui ment DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS THIS CERTIFICATE SUPERCEDES AND REPLACES ALL PREVIOUSLY ISSUED CERTIFICATES! City of Clearwater 112 S. Osceola Ave Clearwater, FL 33756 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 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 Christopher McClain/LORRIL ACORD 25 (2001/08) ©ACORD CORPORATION 1988