CERTIFICATE OF LIABILITY INSURANCE (158)A C Qa
CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDM YY)
06/12/2013
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
certificate holder in lieu of such endorsement(s).
PRODUCER Phone: (813) 988 -1234 Fax: (813) 988 -0989
ASSOCIATES AGENCY, INC.
PO BOX 16190
11470 N. 53RD ST.
TEMPLE TERRACE FL 33687
Agency Licit: L062850
CONTACT Tracy
NAME:
PHONE FAX
(NC No, Ext): (813) 988 -1234 ,NC, No): (813) 988 -0989
EMAIL E tracy@associatesins.com
y@associatesins.com
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A : SOUTHERN OWNERS INSURANCE CO.
10190
INSURED
AIRCO MECHANICAL CONTRACTORS, INC.
14100 HONEYWELL ROAD
LARGO FL 33771
INSURER B : AUTO OWNERS INSURANCE CO.
18988
INSURERC : FCCI INSURANCE CO.
10178
INSURER D:
206i4s1,$. ;_ �..._.,
'" °
INSURER E :
02/10/14
INSURER F :
$
COVERAGES
CERTIFICATE NUMBER: 280835
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
ADM_
INSR
SUER
WVD
.r,
POLICY j� "
� ICY EFF
p DmYY)
POLICY EXP
IMMIODmYY)
LIMITS
A
GENERAL
LIABILITY
COMMERCIAL GENERAL
LIABILITY
OCCUR
206i4s1,$. ;_ �..._.,
'" °
- 02%10/13
"e?
02/10/14
EACH OCCURRENCE
$
1,000,000
X
DAMAGE TO RENTED
PREMISES (Ea occurence)
$
300,000
CLAIMS -MADE
I X
MED. EXP (My one person)
$
10,000
PERSONAL & ADV INJURY
$
1,000,000
GENERAL AGGREGATE
$
3,000,000
GEN'L AGGREGATE
LIMIT
PRO JECT
APPLIES PER
PRODUCTS - COMP /OP AGG
$
3,000,000
7 POLICY
LOC
EMPLOYEE BENEFITS LI
$
1,000,000
B
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
SCHEDULED
AUTOS
NON -OWNED
AUTOS
4345206801
02/10/13
02/10/14
COMBINED SINGLE LIMIT
(Ea accident)
$
1,000,000
BODILY INJURY (Per person)
$
X
BODILY INJURY (Per accident)
$
X
X
PROPERTY DAMAGE
(per accident)
$
$
B
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
4345206804
02/10/13
02/10/14
EACH OCCURRENCE
$
2,000,000
AGGREGATE
$
2,000,000
DED RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER /EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
Y/N
N / A
001 -WC13A -62050
06/27/13
06/27/14
OTH
i WORSTAMrrs ER
$
E.L. EACH ACCIDENT
$
1,000,000
E.L. DISEASE -EA EMPLOYEE
$
1,000,000
E.L. DISEASE- POLICY LIMIT
$
1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
CERTIFICATE HOLDER
CANCELLATION
City of Clearwater
100 S. Myrtle Avenue
Clearwater, Fl 33756
Attention:
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 REPRESENTATIVE
Trevor McCarthy
•
ACORD 25 (2010/05)
2010 AGORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD