CERTIFICATE OF LIABILITY INSURANCEACORD,? CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY)
08/28/2009/2009
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
MARSH USA INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
3475 PIEDMONT ROAD NE, SUITE 1200 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ATLANTA, GA 30305 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
713170-FIBER-CAS-09-10
•--- .............
. INSURERS AFFORDING COVERAGE NAIC #
__
--
INSURED
..•
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INSURER A: Federal Insurance Company 20281
FPL FIBERNET, LLC --
_
ATTN: CRISTINA VALDES INSURER B: New Hampshire Insurance Company 23841
9250 W FLAGLER STREET ^
MIAMI, FL 33174 INSURER c: National Union Fire Ins Co Pittsburgh PA 19445
_ ____.,._._._ ....r.-,
..
.
INSURER D'
._. ._-.. ......----
INS U
LIRER E:
COVERAGES -
-.
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUE D ID-,.- T ...
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.
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INS ADD'L
LTR INSR TYPE OF INSURANCE POLICYNUMBER _
OLICY EFFECTIVE POLICY EXPIRAT J
ION LIMITS
DATE (MMlDDlYY) DATE (MM/DD/YY)
A GENERAL LIABILITY EACH OCCURRENCE
1.000.00
X
COMMERCIAL GENERAL LIABILITY 3711-09-31 09/15/09 09/15/10
DAMAGE TO RENTED rence .
$ 1,000,000
CLAIMS MADE LI ^ OCCUR MED EXP one person)
(Any
$ 1 O OOq
._. PERSONAL & ADV INJURY $ ` 1
000
00C
_
,,„ ,
,
-...._..
--
.. .....
ENERAL AGGREGATE
.` ^°.__.
OO OO
i _
t
GENERAL AGGREGATE LIMIT APPLIES PER
PRO-
•:J
;_
?- .._. _
.- - -
PRODUCTS - COMP/OP AG
1 000,00
POLICY LOC
X JECT ... .._.
A AUT OMOBILE LIABILITY
Y 7352- .,A
i
7f1f1n
20 09/1 09/15/10
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,00
X AN
AUTO
L j i
ALL OWNED AUTOS BODILY INJURY $
SCHEDULED AUTOS ?„ ..
77
.:
` Per person)
-......__
HIRED AUTOS ....
o•
- -
L_f::G.I iL i I JC SR` /CS
E
BODILY INJURY .,.....-__
$
NON-OWNEDAUTOS (Per accident)
PROPERTY DAMAGE
(Per accident) $
GARAGE LIABILITY
7 (? - AUTO ONLY - EA ACCIDENT
^-
- $
ANY AUTO AN EA ACC
OTHERTH $
wR
\h? AUTO ONLY:
AGG l"
$
EXCESS/UMBRELLA LIABILITY ,E rC •••'5?,.? EACH OCCURRENCE $
OCCUR CLAIMS MADE
.,, 1. AGGREGATE $
DEDUCTIBLE ?.....-..
°-- _
- --•
$
RETENTION $
B WORKERS COMPENSATION AND WC 7207708 (AOS) 09/15/09 09/15/10 WC STATU- OTH-
X
1
EMPLOYERS'LIABILITY "
--.TORY1 IMT
I
B
ANY PROPRIETOR/PARTNER/EXECUTIVE WC 7207709 (CA)
)
09/15/09
09/15/10
.L. EACH ACCIDENT
-•---- _
$ 1,000,00
B
OFPICER/MEMBEREXCLUDED?
WC 7209332 (TX)
09/15/09
09/15/10
.L. DISEASE-EA EMPLOYE -.
$ 1,000,00
B SPECIAesPribeunder Wow
WC 1591038 (WI)
09/15/09
09/15/10
.L. DISEASE - POLICY LIMIT
$ 1,000,00 _
C OTHER WC 7209331 (FL, OR) 09/15/09 09/15/10
DESCRIPTION OF OPERATIONSlLOCATIONSA/EHICLESlEXCWSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CITY OF CLEARWATER IS NAMED AS ADDITIONAL INSURED AS RESPECTS GENERAL
LIABILITY.
CERTIFICATE HOLDER ATL-001888844-16 CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CITY OF CLEARWATER FLORIDA EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
CITY HALL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT
112 SOUTH OSCEOLA AVENUE ,
CLEARWATER, FL 33756 BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND
UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTO P
REgENTATNE
of a
Inc.
Ted L- Young
m%.vr%u ca kzuu 11"01 0 ACORD CORPORATION 1988
IMPORTANT
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).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s),. 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.
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