CERTIFICATE OF LIABILITY INSURANCE (152)r_lior ip: 292011 80MCKIMCRE
ACORD.M CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/)
9/02/2010
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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),
PRODUCER NAME- I Cyndy Cagle
BB&T Insurance Services, Inc. _
PHONE336 547-2137 a Na , 8888318409
AIC No Ext : _
3318 West Friendly Ave., ADDRESS: ccagle@bbandt.com -
Ste. 400 80MCKIMCRE
CUSTOMER Ip #:
Greensboro, NC 27410 _ INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A: XL Specialty Insurance Company 37885
McKim 81 Creed, P A INSURER B
243 North Front Street INSURER C :
Wilmington, NC 28401
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMbt:K:
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
R
T TYPE OF INSURANCE NSR p POLICY NUMBER MM/DD/YYYY MMIDD E
/YYYY
LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
-
COMMERCIAL GENERAL LIABILITY E"'fib NT D
PREMISES Ea occurrences
$
CLAIMS-MADE F70CCUR MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
POLICY JECT F-] LOC $
..... AUT OMOBILE LIABILITY RECENE COMBINED SINGLE LIMIT
(Ea accident) $ _
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED AUTOS
BODILY INJURY (Per accident) J y
$
SCHEDULED AUTOS
HIRED AUTOS SEP 13 20' 0
PROPERTY DAMAGE
.`...'
(Per accident) -_.....,?,..,
$
NON-OWNED AUTO S $
.. OFFICIAL RECOR
UMBRELLA LIAR OCCUR 7EGISM EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEDUCTIBLE
L $
.. _
- --- `PiETENTION-. _ ____ - ....._
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$
OFFICERJMEMBER EXCLUDED? ?
(Mandatory In NH) NIA
E.L. DISEASE - EA EMPLOYEE
$
if yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
A Professional
Liability DPR9686568 9105/2010 09/05/2011 $5,000,000 Per Claim
$7,000,000 Aggregate
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
CERTIFICATE HOLDEK l.N1Y l.CLLNI IVIY Iv Maya IW1 Iwn-r a
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: City Clerk
P.O. Box 4748 AUTHORIZED REPRESENTATIVE
Clearwater, FL 33758-4748 S*A&47f_C _
I --
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