CERTIFICATE OF LIABILITY INSURANCE (2),acv CERTIFICATE OF LIA
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONL'
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITU
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the p
the terms and conditions of the policy, certain policies may require an e
certificate holder in lieu of such endorsement
PRODUCER C&OFCLE WAN
BWD Group LLC
113 S. Service Road JAN 0 5 2011
Jericho NY 11753
VAMA M
INSURED
Bright House Networks, LLC.
700 Carillon Parkway (Suite 6)
St. Petersburg FL 33716
DATE (MM/DDIYYYY)
BILIW INSURANCE 12/23/2010
'AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
rE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
Ilicy(ies) must be endorsed. U SUBROGATION IS WAIVED, subject to
idorsement. A statement on this certificate does not confer rights to the
N
NAME
PHONE FAX
A/C No
E?IA?41L
ADDRESS:
_•T
INSURERS) AFFORDING COVERAGE NAIC #
INSURER A:Natignal Union Fire Tns Co Pi 1 9445
INSURERB-Illinois Natipnal Incur, 7
INSURER C : W
INSURERD:St. Pal]1 Fire &__ Marine Insu a 24J67
INSURER E : _
INSURER F
COVERAGES CERTIFICATE NUMBER: 206305920
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUKtU NAMLU AbVVL t-UK Int I'ULI%.T rr-M1Uu
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.
INSR AD L UBR ;, POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INS WVD PO M MMIDDIYYYY MMIDDIYYYY LIMITS
A GENERAL LIABILITY 4406139 1/2011--._ /12012.,
-- OCCURRENCE --- -
-EACH
-------= -
-$2;000-000
X COMMERCIAL GENERAL LIABILITY n
JAN 0 7 2011 DAMAGE TO RENTED
PREMISES (Ea occurrence)
$1, 000, 000 ,-
CLAIMS-MADE FE OCCUR MED EXP (Any one person) SEXCLUDED _
PERSONAL BADV INJURY $2,000,000
,?•? [ /,, r??`
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V
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b
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4
L 1`
? GENERAL AGGREGATE $20,000,000
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ry
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? DEPT
GEN'L AGGREGATE LIMIT APPLIES PER: LLGISLAWE51VC5 DEPT PRODUCTS- COMP/OPAGG $2,000,000
PRO X Per Loc Agg $4,000,000
LOC
JEC
POLICY
A AUTOMOBILE LIABILITY 3976823 1/1/207.1 /1/2012 ECOMBINI-LI SINGLE LIMIT
aaociden„t
2 000j000
x ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
NON-OWNED
PROPERTY DAMAGE
$
X HIRED AUTOS X Per accident
AUTOS
D X UMBRELLA LIAB X OCCUR QK06503168 1/1/2011 /1/2012 EACH OCCURRENCE $5,000,000 _
_
EXCESS LIAR CLAIMS-MADE AGGREGATE $S,000,000
DIED X RETENTION $ 101 0 0 0 $
A WORKERS COMPENSATION 061966999(CA) 1/1/2011 /1/2012 X WCSTATU- OTH-
1 TORY LIMITS I ER
B AND EMPLOYERS' LIABILITY YIN 061966998(AOS) 1/1/2011 /1/2012 --
B ANY PROPRIETOR/PARTNER/EXECUTIVE 061967000 (FL) 1/1/2011 /1/2012 E.L. EACH ACCIDENT $1,000,000
C ?
OFFICER/MEMBEREXCLUDED7 N
(Mandatory In NMI NIA 061967001(NY/MI) 1/1/2011 /1/2012 •'
ISEASE - EA EMPLOYE
FE
$1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
DISEASE- POLICY LIMIT
EL-
$1, 000, 000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
Re: 2530 Drew Street, Clearwater, FL 34625 Certificate holder is included a s additional
insured as per written contract or agreement.
e
f`AAIf`FI 1 ATlnIJ
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
112 South Oscala Ave. ACCORDANCE WITH THE POLICY PROVISIONS.
Clearwater FL 34616-0000
AUTHORIZED REPRESENTATIVE
C C LE2i - nn
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e A_CORD ...._?--..name and _.a...- - -.. .
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