CERTIFICATE OF LIABILITY INSURANCE (97)17251
Q.CORD- CERTIFICATE OF LIABILITY INSURANCE
2/09
12/30/ DATE 2/30/2009
PRODUCER Commercial Lines - (727) 796-6666
Wells Fargo Insurance Services Southeast 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.
311 Park Place Boulevard, Suite 400
Clearwater, FL 33759-3923 INSURERS AFFORDING COVERAGE NAIC #
INSURED Tampa Bay Systems Sales
Inc, dba Tampa Bay Trane INSURER A: WeStrield Insurance Company 24112
, INSURER B: Continental Casualty Company .20443
PO BOX 18547 INSURER c: FFVA Mutual Insurance Company 10385
INSURER D:
Tampa, FL 33679 INSURER E:
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
LTR ADD'L
NSR
TYPE OF INSURANCE
POLICY NUMBER POLICY EFFECTIVE
DATE M POLICY EXPIRATION
DATE MM DD/YY LIMITS
A GENERAL LIABILITY CMM1946402 12/31/2009 12/31/2010 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY DPREMISES (Fa occummce) AMAGE TO RENTED $ 150,000
D CLAIMS MADE FRIOCCUR MED EXP (Any one person) $ 10,000
X Blanket Al PERSONAL & ADV INJURY $ 1,000,000
X Blanket Waiver GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
POLICY PRO LOC
A AUT OMOBILE LIABILITY CMM1946402 12/31/2009 12/31/2010 COMBINED SINGLE LIMIT
$
X
ANY AUTO (Ea accident) 1,000,000
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per Person) $
X HIRED AUTOS ((?? ?jn BODILY INJURY
X
NON-OWNED AUTOS
?J
C 3 12009
(Per accident) $
PROPERTY DAMAGE
CIFFIC
RECORDS A
JD
(Per accident) $
GARAGE LIABILITY LEGIS TIVE SRVCS DE PT AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
B EXCESS/UMBRELLA LIABILITY 2090856223 12/31/2009 12/31/2010 EACH OCCURRENCE $ 7,000,000
X OCCUR 0 CLAIMS MADE AGGREGATE $ 7,000,000
$
DEDUCTIBLE $
F
] RETENTION $ $
WORKERS COMPENSATION AND
9477
WC840001
010
1101!2
1/01/2011 X WC STATU- OTH- 500,000
-._
EMPLOYERS' LTASILITY--------------.- Y
.....: -.:-;-
._ _- ;_._. ..-..,-__Y-.-._._..=_.- -E•.L.-EAeH;?,cciDENr-----.-.. __.?-_:_ 500_000.._
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
E.L. DISEASE - EA EMPLOYEE
$ 500,000
If yes, describe under -
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
For Information Only
f.;tKIIFIC.AItMVLUCK l?H1Y6rGLWIIWN '--^/ "--'--- .-_... -,..._.--
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
CITY OF CLEARWATER NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
112 S. OSCEOLA AVENUE IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
CLEARWATER FL 33756 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE /i-nJC/1
l?' lln I I \
ernRn g? r9nnimm o s.2 1092801
(a ACORD CORPORATION 198f
y ?
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.
ACORD 25-S (2001108) 2 of 2 #S915260/M915043