CERTIFICATE OF LIABILITY INSURANCE (174)OP ID: SD
'4`C.°. - CERTIFICATE OF LIABILITY INSURANCE
DATE /28 /13YY)
06/28/13
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:941- 366 -8424
Atlas Insurance Fax: 941 - 552 -4099
PO Box 17669
Sarasota, FL 34276 -0669
Thomas W. Kochis, CIC, CRM
NAME:
PHONE FAX
(A/C, No. Ext): (A/C, No):
E -MAIL
ADDRESS:
PRODUCER
CUSTOMER ID #: ABSOL -1
INSURER(S) AFFORDING COVERAGE
INSURER A: FCCI
NAIC #
33472
INSURED Absolute Aluminum, Inc.
Absolute Aluminum &
Construction Company
1220 Ogden Road
Venice, FL 34292
INSURERS:
LIABILITY
COMMERCIAL GENERAL LIABILITY
INSURER C
INSURER D :
GL00089284
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INSURER E :
j
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INSURER F :
EACH OCCURRENCE
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
W VD
POLICY NUMBER
POLICY EFF
(MM /DD/YYYY)
POLICY EXP
(MM /DD/YYYY)
LIMITS
A
GENERAL
LIABILITY
COMMERCIAL GENERAL LIABILITY
OCCUR
GL00089284
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,M�`18/Q8/12
d
j
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08/08/13
EACH OCCURRENCE
$
1,000,000
X
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$
100,000
CLAIMS -MADE
X
MED EXP (Any one person)
$
5,000
X
Contractual Liab
PERSONAL & ADV INJURY
$
1,000,000
X
XCU Liability
GENERAL AGGREGATE
$
2,000,000
GE
'L AGGREGATE LIMIT
POLICY n PRO
APPLIES PER:
PRODUCTS - COMP /OP AGG
$
2,000,000
LOC
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
e " t
CA0014034 - "� "'' '
$500 COMP
$500 COLL
I ,b r
a i/08/1�2
08/08/13
COMBINED SINGLE LIMIT
(Ea accident)
$
1,000,000
X
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
X
X
$
$
A
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
UMB000089611
08/08/12
08/08/13
EACH OCCURRENCE
$
2,000,000
AGGREGATE
$
2,000,000
DEDUCTIBLE
RETENTION $ 10,000
$
_
X
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/N
ANY PROPRIETOR/PARTNER /EXECUTIVE
OFFICER /MEMBER EXCLUDED? ❑
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
001WC13A38676
07/01/13
07/01/14
X TWOC Y ATIU- S 0T-
E.L. EACH ACCIDENT
$
1,000,000
E.L. DISEASE - EA EMPLOYEE
$
1,000,000
E.L. DISEASE - POLICY LIMIT
$
1,000,000
A
Leased /Rented
Equipment
CM00047494
08/08/12
08/08/13
Limit
Deductibl
100,000
500
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space Is required)
COVERAGE SUBJECT TO FORMS, CONDITIONS AND EXCLUSIONS.
CANCELLATION
1
CITYCLI
City of Clearwater
100 S. Myrtle Ave.
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
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ACORD 25 (2009/09)
01988 -2009 ACORD CORPORATION. All rights reserved.
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