CERTIFICATE OF LIABILITY INSURANCE (94)11762
ACORO
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
,T1 12/16/2009
PRODUCER Commercial Lines - (727) 796-6666 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Wells Fargo Insurance Services Southeast Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
311 P
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d ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
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, Suite 400
Clearwater, FL 33759-3923 INSURERS AFFORDING COVERAGE NAIC #
INSURED Image One Corp dba INSURER A. Hartford Fire Insurance Co. 19682
6206 Benjamin Rd #301 INSURERS;
INSURER C:
INSURER D:
Tampa FL 33634 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.
LTR
NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE
DATE MM POLICY EXPIRATION
MM DD
LIMITS
A GENERALLIABILITY 21SBAL11614 1/1/2010 111/2011 EACH OCCURRENCE S 1,000,000
X COMMERCIAL CENERAL LIABILITY DAMAGE TO RENTED $ 300,000
CLAIMS MADE a OCCUR MED EXP (Any one person) S ' 10,000
PERSONAL & ADV INJURY S 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
X POLICY PRO-
JECT LOC
A AUT OMOBILE LWBILITY 21 UECL14905 1/t/2010 1/1/2011 COMBINED SINGLE LIMIT
X
ANY AUTO ?
w ?
(Ea accident) $ 1,000,000
ALL OWNED AUTOS C
BODILY INJURY
SCHEDULEDAUTOS
r?00
(Per person) $
X HIRED AUTOS DEC 17 ` BODILY INJURY
X
NON-OWNED AUTOS
(Per accident) $
OFFI CIAL RECORD AND
A
GE
e
LEGI SLATIVE SRVC DEPT MA
r a cident)
Pe $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
1 R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A EXCESS/UMBRELLALIABILrrY 21SBAL11614 1/112010 1/112011 EACH OCCURRENCE $ 3,000,000
X OCCUR FICLAIMS MADE AGGREGATE $ 3,000,000
S
_ DEDUCTIBLE----_. ... S
X RETENTION $ 10,000 ....-
A WORKERS COMPENSATION AND 21 WECDU9$11 1/112010 1/1/201 T x WC STATU- OTH-
EMPLOYER$' LIABILrrY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$ 1,ODq 0.00
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1,000,000
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
CERTIFICATE HOLDER IS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY
1W11 vay 1YVL1%,W IVI INVII-r OY111UHL
CITY OF CLEARWATER
ATTN: CITY CLERK
P O BOX 4748
CLEARWATER FL 33758
ACORD 25 12001/081 4 .,s '1 1
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 DO $0 SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED REPRESENTATIVE
n Ae'r%or% rnonneArlnAl Aden
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 terns 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.
ACORD 25-S (2001/08) 2 of 2 #S915260/M915043