CERTIFICATE OF LIABILITY INSURANCE (5)1,?j -11 X11111 11.-10 C1rl -)44 ?.7 -ice L:ll AAr-q
CERTIFICATE OF LIABILITY INSURANCE D" TE f2020,a '
THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION
PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
BAY AREA INSURANCE, INC. HOLDER- THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
9067 BELCHER. ROAD
FLORIDA 33782
PINELLAS PARK ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
,
INSURERS AFFORDING COVERAGE NAIC #
7Nsu D INSURER A: WESTERN HERITAGE INSURANCE CO
688 SKATE SHOP INC. INSURER a!
1426 SOUTH MLK AVE INSURER C;
CLEARWATER, FLORIDA 33756
ENSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
ANY REQUIREMENT
,
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,
INS ADV' POLICY NUMBER POUCY EFFECTIVE POLICY EXPIRATION LIMITS
LTR IN$R TYPE OF INSVRANCE DATE MMIDDIYY DATE MMMOPM
(OF ERA4 UABlLIT f 88098 08!20/2010 08/20/2011 EACH A To OCCCVRRE NCE $ 1,000,000
A X x COMMERCIAL GENERAL LIABILITY PREMI FA Eo vqurence S 10(),000
I?f CLAIMS MADE I X OCCUR MED EAP (Arty One person) S 5,000
'
V INJURY a 11000,000
PERSONAL 6 AD
2.000,000
GENERA AGGREGATE a
I
OEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS • COMPIOP AGO 5 2,000,000
I POUCV JEcT 71LQC DEDUCTIBLE a 250
AUTOMOBILE LIABILITY 00 DINED SINGLE LIMIT 5
(?o orcldenl)
_ ANY AUTO
ALL OWNED AUTOS
SCHEDULEOAUTOS 60OILY INJURY 5
- (Pvrpesvn)
..
HIRED AUTOS
BODILY INJURY a
NON-OWNED AUTOS (Per BC[I49nU
•??'+" PROPERTY DAMAGE g
s.,% i (PerSwAdent)
GAftAGELWBILITY AUTO ONLY - EAACOIDENT 5 -
Lf
FC
70 A
. EA ACC S OTHER THAN
ANY AV I
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- AUTO ONLY: AGG S
E
EXCESS/UM BRELLA LIABILITY EACH OCCURRENCE S
OCCUR CLAIMS MADE AGOREOAYE S
'
a
DEDUCTIBLE
RETENTION a a
TH-
WORKHRS COMPENSATION AN? TORY LIMITS ER
EMPLOYERS' LVIBIUTY E.L. EACH ACCI(KNT S
ANY PROPRIETORIPARTNEWEKECUTIVE
DISEASE • EA EMPLOYE a
E
L
OFFICERIMEMBER EXCLUDED? .
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If y6s, descHha under E.L. DISEASE -POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
DF%CaIaTION OF OPERATIONS I LOCATIONS ]VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE AEOVF DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 110 DAYS WRITTEN
ADDITIONAL INSURED:
NOTICE TO THE CERTIFICATE HCR NAMED TO THE LEFT. BUT FAILURE TO 40 SO SHALL
CITY OF CLEARWATER INPOSE NO OBLIGATION OR LIABILITY OF ANY KING UPON THE INSURER, ITS AOENTB OR
1 pq $ MYRTLE
CLEARWATER, FLORIDA 33756 REPRESENTATIVES.
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