CERTIFICATE OF LIABILITY INSURANCE (192)A� ,®
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM /DD/YYYY)
7/1/2013
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
Weekes & Callaway, Inc.
3945 West Atlantic Avenue
Delray Beach FL 33445 -3902
CONTACT Sandi Maudsley, CRIS
NAME: y �
(A/CNIo.E.t: (561)278 -0448 I A/C. Not: (561) 278 -2391
E -MAIL smaudsle @weekescallawa com
ADDRESS: y y'
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A :Amerisure Insurance Company
19488
INSURED
StoreTech, Inc.
1225 NW 17th Ave
Suite 104
Delray Beach FL 33445
INSURERB:Amerisure Mutual Ins Co.
23396
INSURER C :AmeriSure Companies
INSURERD:
EACH OCCURRENCE
INSURERE:
DAMAGE TO RENTED
PREMISES (Ea occurrence)
INSURER F:
MED EXP (Any one person)
CL137104084
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
Vi/VD
POLICY NUMBER
POLICY EFF
(MM /DD/YYYY)
POLICY EXP
(MM /DD/YYYY)
LIMITS
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
GL2063189
7/9/2013
7/9/2014
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 100,000
MED EXP (Any one person)
$ 5,000
CLAIMS -MADE X OCCUR
PERSONAL & ADV INJURY
$ 1,000,000
X
Blkt Additional Insured
GENERAL AGGREGATE
$ 2,000,000
X
Blkt Waiver Subrogation
PRODUCTS - COMP /OP AGG
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X I POLICY 5F1 I jFc? [1 LOC
$
B
AUTOMOBILE
X
_
X
LIABILITY
ANY AUTO
ALLOWNED
AUTOS
HIRED AUTOS
-
_
x
SCHEDULED
AUTOS
NON -OWNED
AUTOS
CA2063187
7/9/2013
7/9/2014
D
Ea acct identSINGLE LIMIT
$ 1,000,000
$
BODILY INJURY (Per person)
BODILYINJURY(Peraccident)
$
PROPERTY DAMAGE
(Per accident)
$
Medical payments
$ 5,000
B
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
CU2063191
7/9/2013
7/9/2014
EACH OCCURRENCE
$ 8,000,000
AGGREGATE
$ 8,000,000
$
DED I X I RETENTION $ 0
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR /PARTNER /EXECUTIVE Y / N
OFFICER /MEMBER EXCLUDED?
(Mandatory in NH)
Eyes, descr Lie under _ ... ... -w'*
DESCRIPTION OF OPERATIONS below
N/A
.. _....
ffC2086797
_ _ ... __. _
4/1/2013
4/1/2014
X I TORY I IMITS I I FR
E.L. EACH ACCIDENT
$ 1,000,000
$ 1,000,000
--- ,._..��
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
B
CPP2063190
7/9/2013
/9/2014
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
P
JUL 0 '213
(727) 562 -4576
City of Clearwater
100 S Myrtle Ave
Suite 210
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
John Didonato /SM ,-
_'"
'
ACORD 25 (2010/05)
INS025 (201005).01
-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD