CERTIFICATE OF INSURANCE (256)
ACOBQM
PRODUCER (352) 245 - 5455
CI ifford Insurance Center
9790 SE 160th Lane
Summerfie~d, FL 34491
FAX (352)245-9866
DATE (MMlDDIYYYY)
01/25/2005
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.
CERTIFICATE OF LIABILITY INSURANCE
INSURERS AFFORDING COVERAGE
INSURED North County E I ectr i C I nc
16548 79th Terr N
Palm Beach Gardens. FL 33418
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
NAIC#
32700
cnVI=IUC::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 MAYBE 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 DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY B05012501542 01/29/2005 01/29/2006 EACH OCCURRENCE $ 500.000
- DAMAGE TO RENTED
X COMMERCIAL GENERAL LIABILITY $ 100,000
=:=J CL..IMS WIDE [K] OCCUR PRI=MI!':I=!':
MED EXP (Any on,e person) $ 10,000
A X $250.PD Deductible PERSONAL & ADV INJURY $ 500,000
-
GENERAL AGGREGATE $ 1,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COM~OPAGG $ 1,000,000
I n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- (Ea accident) $
ANY AUTO
-
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
HIRED AUTOS BODILY INJURY
- $
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
" (Per accident)
~RAGE LIABILITY AUTO ONLY. EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
:=J OCCUR D CLAIMS MADE AGGREGATE $
$
==i' DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I we STATU- IOJ~-
EMPLOYERS' LIABILITY $
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? I, E..L DISEASE, lOA EMPLOYE!' $ ..", ' '--
lfyes,lrescfibe uriaer-' --, ---- ~-~---- --- -...---------.-: --- ,,'n
SPECIAL PROVISIONS below E.L. DISEASE. POLICY LIMIT $
OTHER
DESCRIPTION OF OPERA nONS I LOCATIONS I VEHICLES I EXClUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICA TE H LDER
CANCELLA TION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Clearwater
112 S. Oscecola Avenue
Clearwater. FL 33756
ACORD 25 (2001/08) FAX: (813) 562-4052
@ACORD CORPORA liON 1988