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CERTIFICATE OF LIABILITY INSURANCE
OP ID: WN ACOl2U$ CERTIFICATE OF LIABILITY INSURANCE ` � DATE 06!06/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIOg. 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 certificate holder in lieu of such endorsement(s). PRODUCER Phone:954- 792 -4300 Chase Insurance Agency Inc Fax 954791 9344 P O Box 17497 - - Plantation, FL 33318 -7497 MIKE CHASE NAME: CONTACT PHONE FAX (A/C• No, Ext): (A/C, No): E -MAIL ADDRESS: PRODUCER CLEAR -1 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Clearwater Towing Service Inc 1955 Carroll St Clearwater, FL 33765 INSURER A: Castlepoint Nat'l Ins Co 40134 INSURER B : INSURER C : TWP DY00438 12 INSURER D : 06/09/2012 INSURER E : EACH OCCURRENCE INSURER F : 1,000,000 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. 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 LTR TYPE OF INSURANCE ADDL INSR SUBR VD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR TWP DY00438 12 06/09/2012 08/08/2013 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED PREMISES (Ea occurtence) $ 100,000 CLAIMS -MADE X MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY PRO- LOC JECT $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS TWP DY00438 12 , "--, i - - 06/09/2012 - -� 08/08/2013 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ X X $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE . .. ' EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N N / A __ _, WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ below E.L. DISEASE - POLICY LIMIT $ A A On Hook & Cargo Garagekeepers Lega TWP DY00438 12 TWP DY00438 12 06/09/2012 06/09/2012 08/08/2013 08/08/2013 $1000 DED $500 DED Varies Varies DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule If more space is required) GRGEKEPRS LEGAL LIAB 1955 CARROLL ST, CLEARWATER, FL $500,000 & 1597 B NORTH HERCULES, CLEARWATER, FL. $50,000 & SW CORNER LOT 21 CARROLL ST $150,000 CERTIFIC CANCELLATION CLEAP01 Clearwater Police Dept P 644 Pierce St Clearwater, FL 34616 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. RFCEIVFD AUTHORIZED REPRESENTATIVE CITY Y O F CLEARWATER A) ' C JUN 13 2013 ACORD 25 (2009/09) ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD RISK MANAGEMENT 9173 VEHICLE SCHEDULE 1 Insured: Clearwater Towing Sery Inc Policy Term: 06/09/12 To 08/08/13 Vehicle Information YEAR MAKE MODEL COMPRE- COLLISION HENSIVE ON HOOK & CARGO VEHICLE I.D. 1996 Freightlin Tractor 1000 1000 100,000 1FUYDXYB9TH772923 1988 WallyMo Trailer 1000 1000 N/A 4VMH210KAB12M0648 1987 Landoll Trailer 1000 1000 N/A 1LH330RH7H1003396 1997 Landoll Trailer 1000 1000 N/A 1 LH660UH5 V1008944 1999 Landoll Trailer 1000 1000 N/A 1LH330RG5X1A09982 2003 Ford 4 Car Flat 1000 1000 250,000 3FDXF75X33MB06256 1999 Fontaine Trailer 1000 1000 N/A 4LF4S5031X3508351 2005 Ford Flatbed 1000 1000 100,000 3FRNF65F55V102917 2005 Ford Flatbed 1000 1000 100,000 3FRNF65F75V178428 2006 Int'l Wrecker 1000 1000 150,000 1HTMMAAM96H230274 2005 Ford Flatbed 1000 1000 100,000 3FRNF65F75V205417 2000 Kenworth Wrecker 1000 1000 500,000 1NKWLBOX8YJ845516 2006 Haulmark Trailer -En 1000 1000 N/A 1GHGB28246G083740 2005 Int'l Wrecker 1000 1000 150,000 1HTMKAAN25H107820 2007 Ford Flatbed 1000 1000 75,000 3FRWX65B27V507795 2002 Kenworth Tractor 1000 1000 500,000 1XKWPBTX82J892056 2005 Peterbilt Tractor 1000 1000 250,000 1XP5DB9X15N855336 2007 Peterbilt Flatbed 1000 1000 250,000 2NPLHD7X67M696496 2009 Peterbilt 4 Car 1000 1000 250,000 2NPLHN7X29M764575 2007 Miller Trailer 1000 1000 N/A 1M9CSFC207T486578 2008 Ford Flatbed 1000 1000 100,000 3FRWF65B58V676276 2008 Ford Flatbed 1000 1000 100,000 3FRNF65C38V080457 2005 Freightlin Tractor 1000 1000 250,000 1FUJA6AV55LU99164 2010 Dodge 3500 1000 1000 100,000 3D73Y3CL9AG131895 2008 Miller Trailer 1000 1000 N/A 1M9CSFC2X8T486671 2009 Peterbilt Flatbed 1000 1000 250,000 2NPLHN7X59M779216 2007 Cadillac Escalade 1000 1000 N/A 1GYFK66847R179552 2011 Ford Flatbed 1000 1000 500,000 3FRWF6FC4BV145567 2011 Ford Wrecker 1000 1000 150,000 1FDUF5GT2BEB76532 2012 Ford Flatbed 1000 1000 100,000 3FRWF6FC8CV198872 2007 Ford SelfLoader 1000 1000 75,000 1FDXF47PX7EA69147 2012 Ford Flatbed 1000 1000 100,000 3FRWF6FC3CV198875 2006 Ford Wrecker 1000 1000 100,000 3FRWF65F56V344872