CERTIFICATE OF LIABILITY INSURANCE (2),�'� SK80E-1 OP ID: MW
'`��_°�R° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYVVV)
10/12/12
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
PRODUCER
Bay Area Insurence Inc.
3067 Belcher Road
Pinellas Park, FL 33782
INSURED
1426 S M LK J r Ave
Clearwater. FL 33756
Phone: 727-544-8841 � NAME�� Marlea Warrant
Fax:727-544-8842�/oHONE^ .7.27-544-884,�
INSURER(S) AFFORDING COVERAGE
INSURERA: N2ilOf1WId0 �f1S CO Of QfI10fIC2
INSURERB: PfOqfOSSIVO �fIVO �f1S
%2%-544-8842
NAIC p
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NONVITHSTANDING 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS.
INSR rypE OF INSURANCE POLICV EFF POLICV EXP
LTR INSR NND POLICV NUMBER MMIDDIVVVV MMIDDIVVVV LIMITS
GENERALLIABILITY EACHOCCURRENCE $ ��OOO�OOO
A X commeRan�ceNeRn�unewrv X ACP5905729939 07/O6/12 07/O6/13 omm�ceroReNreo 100,000
PREMISES Eaoccurrence $
CLAIMSMADE X�OCCUR MEDEXP(Anyoneperson) $ S�OOO
PeRSONn�anoviNduRV a 1,000,000
ceNeRn�nccRecnre a 2,000,000
ceN��nccRecnreumirnPPUesPeR�. PROOUCrs-comwoPncc a 2,000,000
X Poucv PRO- $
decr �oc
AIJrOMOBILELIABILITY COMBWEDSINGLELIMIT ��OOO�OOO
Eaacciden[ $
B nNVnuro X 01882447-0 10/04/12 10/04/13 eooi�viNduRV�Perperson� a
ALLOWNED SCHEDULED BODILVINJURV(Peracciden[) $
AUTOS X AUTOS
NON-OWNED PROPERTVDAMAGE $
HIREDAUTOS AUTOS Peracciden[
$
UMBRELLALIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
WORKERSCOMPENSATION WCSTATU- OTH-
AND EMPLOVERS' LIABILITY � � N TORV LIMITS ER
ANV PROPRIETOR/PARTNER/EXECUTNE EL EACH ACCIDENT $
OFRCER/MEMBEREXCWDED? � NIA
(MantlatoryinNH) EL.DISEASE-EAEMPLOVEE $
Ifyes describe under
DESCRIPTIONOFOPERATIONSbelow EL.DISEASE-POLICVLIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Atltlitional Remarks Schetlule, if more space is requiretl)
The City of Clearwater is additional insured on the general and auto
liability policies.
City of Clearwater
100 S Myrtle Ave
Clearwater, FL 33756
ACORD 25 (2010/OS)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTCE WILL BE DELIVERED IN
ACCORDANCE WITH 7HE POLICY PROVISIONS.
AIJrHORIZED REPRESENTATIVE
C�
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