CERTIFICATE OF LIABILITY INSURANCE (148)DATE �MMIDDNYYY)
'o!�o° CERTIFICATE OF LIABILITY INSURANCE 06110/2013
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Iiv�DeR. i r+is
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 ceRificate holder is an ADDITIONAL INSURED, the policy�les) 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 Phone: (813) 988-1234 Fax: (813) 988-0989 cON7nCr Sharon
NAME_____ _____—.. _----
ASSOCIATES AGENCY� INC. PHONE /g�g ggg_1234 c No� (813) 988-0989 _
PO BOX 16190 SE- AILO Ex��_ \_ __�______ ____ . _ ---
11470 N. 53RD ST. sharont@associatesins.com
. ADDRESS;__ ____ ___ — ---__— _ —
TEMPLE TERRACE FL 33687 INSURER(S) AFFORDING COVERAGE NAIC #
Agency Lic#: L062850 iNSUReR n: FCCI INSURANCE CO. 10178 _
iNSUReo iNSUaeRe : EVEREST NATIONAL INS.CO.
BAYONET PLUMBING HEATING & AIR CONDITIONING LLC
8950 NEW YORK AVE iNSUReR c: BRIDGEFIELD
HUDSON FL 34667 INSURERD:
��, INSURER E :
I� � INSURER F : � �
�VERAGES CERTIFICATE NUMBER: 280125 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLIC'X 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,
TYPE OF INSURANCE
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
_ � CLAIMS-MADE li_ ._, � OCCUR
I GEN'L AGGREGATE LIMIT APPLIES PER:
'� — � , PRO- r —
� POLICY I LOC
; JECT 1
A �LAUTOMOBILE UABILITY
II X IANYAUTO SCHEDULED
1ALL OWNED � �
AUTOS
POLICY NUMBER POLICV EFF ro
_ __ MMIDD��IMM
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B i� � UMBRELLA LIAB i� ' OCCUR I I i �.3-282 06/09/13 O6/09/14
ExCESS uas CLAIMS-MADE !
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I �DED r RETENTION $ i
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`+ �,� ROW KERS COMPENSATION ; 0830-05995-0 04/01/13 ! 04/01/14
� AND EMPLOYERS' LIABILITY Y/ N � �
! ANY PROPRIETOR/PARTNERIEXECUTIVE , --, I , II i
��, OFFICERIMEMBER EXCLUDEDT � I �� N � q '�, ��� �I � I
'I (ManEatory in NH) ---.. . � �� . �,
. �I yes, d^scribe under i � : '
� DESCRIPTION OF OPERATIONS below . �I_ � __ ,__ ____..___. _ �_____ ____ �___ __ _ ___
_ __.._ _—i I
.__ .. ._.__ ___-_—. .—_______—_ .
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DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedu�e, if more space is required)
City of Clearwater
P.O. Box 4748
Clearwater, FI 34618
Attention:
LIMITS
EACH OCCURRENCE � $
DAMAGE TO RENTED � $
PREMISES (Ea occurence)
MED. EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERALAGGREGATE $
PRODUCTS-COMP/OPAGG $
$
COMBINED SINGLE LIMIT $
(Ea aaident)
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
(per accident)
-- — $
EACH OCCURRENCE $
AGGREGATE $
,$
� r����0��
1,000,000
1,000,000
�n ----...._
TORYLIMITS I ER S _ _____
i E L EACH ACCIDENT �$ �,OOO,OOO
E.L. DISEASE-EA EMPLOYEE $ 'I OOO,OOO
— .�___—_._
� E.L. DISEASE-POLICY LIMIT � $ 'I,OOO,OOO
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
ACORD 25 (2010/05) �O 1988-2010
The ACORD name and logo are registered marks of ACORD
��������Sr'
Mike Rogers