CERTIFICATE OF LIABILITY INSURANCE (165)AR I® CERTIFICATE OF LIABILITY INSURANCE
DATE olrc3 )
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
George H Odiorne Insurance Agency Inc
g "� �
PO Box 830
Brandon FL 33509
CONTACT Megan Manning
NAME: g g
PHONE (813) 685 -7731 I FAX (813) 685 -1823
IA/C. No. Ertl• IA/C. Nol:
ADDRESS :mmanning @odiorneinsurance.cora
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A :FCCI Commercial Insurance Co
33472
INSURED
Lott Sign Service, Inc.
4141 Mowrey Road
Wesley Chapel FL 33543
INSURER B :National Trust Insurance Co.
20141
INSURERC:FCCI Insurance Company
10178
INSURER D :
$ 1,000,000
INSURER E :
$ 100, 000
INSURERF:
$ 5, 000
CERTIFICATE NUMBER:13 /14 All Lines Master
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
SUBR
WVD
POLICY NUMBER
POLICY EFF
IMM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
LIMITS
A
GENERAL
_
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
,,INSR
GL00044028
• •
6/28/2013
6/28/2014
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence)
$ 100, 000
MED EXP (Any one person)
$ 5, 000
I CLAIMS -MADE X OCCUR
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP /OP AGG
$ 2 , 000 , 000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO- n LOC
n l POLICY n
$
B
AUTOMOBILE
_
X
_
—
LIABIUTY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
_
_
SCHEDULED
AUTOS-
NON -OWNED
AUTOS
CA000Th828
_.n. >–
6/28/2013
6/28/2014
COMBINED SINGLE LIMIT
Ea stidentl
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
P.I.P.
$ 10,000
A
X
UMBRELLA UAB
EXCESS LIAB
_
OCCUR
CLAIMS -MADE
OM300089454
6/28/2013
6/28/2014
EACH OCCURRENCE
$ 2,000,000
AGGREGATE
$
$
DED I X I RETENTION$ 10,000
C
WORKERS COMPENSATION
AND EMPLOYERS' UABILITY
ANY PROPRIETOR/PARTNER /EXECUTIVE Y / N
OFFICER/MEMBER EXCLUDED? N
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
59442
4/1/2013
4/1/2014
X I WCY TAM US I 10TH-
FR
E.L. EACH ACCIDENT
$ 500,000
E.L. DISEASE - EA EMPLOYEE
$ 500,000
$ 500 000
E.L. DISEASE - POLICY LIMIT
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space Is required)
City of Clearwater
100 S Myrtle Avenue
Clearwater, FL 33756
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
W Vildibill (C) /MANN
L
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ACORD 25 (2010/05)
INS025 (201005) 01
-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD