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CERTIFICATE OF LIABILITY INSURANCE (2)OP ID: WN ACOR04 CERTIFICATE OF LIABILITY INSURANCE ��" DATE(MM /DD/YYYY) 06/18/2013 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: 954 - 792 -4300 Chase Insurance Agency Inc Fax: 954 - 791 -9344 P 0 Box 17497 Plantation, FL 33318 -7497 MIKE CHASE NAMEACT PHONE FAX (aC, No, Ext): (A/C, No): POLICY EXP /DD/YYYYL 06/18/2014 E -MAIL ADDRESS: PRODUCER CLEAR -1 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE INSURER A: State National Ins Co Inc NAIC # 12831 INSURED Clearwater Towing Service Inc 1955 Carroll St Clearwater, FL 33765 INSURER B : OCCUR INSURER C : INSURER D : X INSURER E : $ INSURER F : 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 SUER WVD POLICY NUMBER POLICY EFF IMM/DD/YYYYUMM .06118/2013 POLICY EXP /DD/YYYYL 06/18/2014 LIMITS EACH OCCURRENCE $ 1,000,000 A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR XNDP- 00259 -00 X DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 CLAIMS -MADE X MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 X POLICY JECT LOC $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS XNDA - 00259 -00 06/18/2013 06/18/2014 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 $ 1 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 XNDA - 00259 -00 XNDA - 00259 -00 06/18/2013 06/18/2013 06/18/2014 06/18/2014 $1000 DED $500 DED 500,000 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space is required) LOC COVERED GKLL 1955 CARROLL ST, CLEARWATER, FL, 1597 B NORTH HERCULES, CLEARWATER, FL.AND SW CORNER LOT 21 CARROLL ST., CLEARWATER, FL. CERTIFICATE HOLDER CANCELLATION CLEAP01 Clearwater Police Dept 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. AUTHORIZED REPRESENTATIVE . Cam. ACORD 25 (2009/09) ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD