CERTIFICATE OF LIABILITY INSURANCE (136)��"'�"� IMPR001 OP ID: KM
`��R"°' CERTIFICATE OF LIABILITY INSURANCE - °"TE,MM,°°'Y"�„` -.
- 12/07/12
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. THI.'5 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 CONTACT
321-725-7000 NAME:
J.W. Edens & Campany PHONE Fnx
Commercial Ins �f Brevard, Inc 321-725-7856 ,vc No eM : ac No :
325 Fifth Avenue, Suite 108 E-MAIL
ADDRESS:
Indialantic, FL 3s":903
Theresa C. O�BrIiBl7 INSURER S) AFFORDING COVERAGE N/41G #
INSURED Imaierial Roofing
Coi�tractor, Inc.
4117 Cox Drive
Larid O'Lakes, FL 34639
�r,suRER n: Canal Indemnity Compan
�r,suReR e: Travelers Indemnity Com
INSURER C :
INSURER D :
INSURER E :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CEI=tTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEO ABOVE FOR THE POLICY PERIOD
INDICATED. N()TWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE �eIAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AIVD CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR 7y�pE OF INSURANCE �DL SUBR POLICY EFF POLICY EXP
LTR , POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
GENERAL LIAHILITY
EACH OCCURRENCE $ 'I,OOO,OOO
l4 i� COMMER::IAL GENERAL LIABILITY GL103941 12/31/12 12/31/13 DAMAGE TO RENTED
PREMISES Ea occurrence $ 5�,���
CLAIfAS-MADE � OCCUR MED EXP (Any one person) $ rJ,�O
_ PERSONAL & ADV INJURY $ 'I �OOO�OO
GENERALAGGREGATE $__ _ Z,OOO,OO
GEN'L AGGREG�A,`FE LIMIT APPLIES PER: PRODUCTS - COMP/0P AGG $ �, OO,OOO
X POLICY PR� LOC $
AUTOMOBILE I.IABILITY Ee aB tleDtSINGLE LIMIT $ ��OOO,OOO
B X ANY AUT(;� BA-333M3132-12 10/22/12 10/22/13 BODILY INJURY (Per person) $
ALL OWNf:D SCHEDULED BODILY INJURY Per accident $
AUTOS AUTOS ( 1
NON-OWNED PROPERTY DAMAGE
HIREDAU"fOS AUTOS Peraccident $
$
UMBRELL�4 LIAB OCCUR EACH OCCURRENCE $
EXCESS L.IAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ g
WORKERS COIYIPENSATION WC STATU- OTH-
AND EMPLOYEIRS' LIABILITY Y� N T RY LIMIT R
ANY PROPRIETpR/PARTNER/EXECUTIVE
OFFICER/MEME���=R EXCLUDED? � N� A E.L EACH ACCIDENT $
(Mandatory in IJ'H) E.L. DISEASE - EA EMPIOYEE $
If yes, describe �.inder
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY L1MIT $
DESCRIPTION OF OPIEfRATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Li�'l� � � �O�L
O�FP���►L R����� ,��
, LE��B.ATNE S Z�`C� �E�'
Cit�l� of Clearwater
112; South Osceola Avenue
Clearwater, FL 33756
ACORD 25 (2011)/05)
CITYCL2
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATNE
Theresa C. O'Brien /���I�� nj D�...�
� L�
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