CERTIFICATE OF LIABILITY INSURANCE (194)ACQO R I
® CERTIFICATE OF LIABILITY INSURANCE
DATE
%5/20 3
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
FEDERATED MUTUAL INSURANCE COMPANY
HOME OFFICE: P.O. BOX 328
OWATONNA, MN 55060
CONTACT
NAME: CLIENT CONTACT CENTER
PHONE FAX
(A/C, No, Ext): 888 - 333 -4949 (A/, No):
507- 4464664
ADDRESS: CLIENTCONTACTCENTER (a1FEDINS.COM
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: FEDERATED MUTUAL INSURANCE COMPANY
13935
INSURED 344 -925 -3
FLORIDA AIR SYSTEMS INC
6600 E BROADWAY AVE
TAMPA, FL 33619
INSURER B:
08/23/2013
INSURER C:
EACH OCCURRENCE
INSURER D:
DAMAGE TO RENTED
PREMISES (Ea occurrence)
INSURER E:
MED EXP (My one person)
INSURER F:
COVERAGES
CERTIFICATE NUMBER: 4
REVISION NUMBER: 0
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
WVD
POLICY NUMBER
POLICY EFF
IMM /DDIYYYY)
POLICY EXP
(MM /DD /YYYYI
LIMITS
.
A
GENERAL
LIABILITY
COMMERCIAL GENERAL LIABILITY
N
N
9365408
08/23/2013
08/23/2014
EACH OCCURRENCE
$1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$50,000
MED EXP (My one person)
CLAIMS -MADE
X
OCCUR
PERSONAL & ADV INJURY
$1,000,000
X
—
BUSINESS OWNER'S LIABILITY
GENERAL AGGREGATE
$2,000,000
PRODUCTS - COMP /OP AGO
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY n JEC RO-
n LOC
A
AUTOMOBILE
X
_
LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
_
_AUTOS
SCHEDULED
AUTOS
NON -OWNED
N
N
9365409
08/23/2013
08/23/2014
COMBINED SINGLE LIMIT
(Ea accident)
$300,000
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE
(Per accident)
UMBRELLA LIAR
EXCESS LIAB
_OCCUR
CLAIMS -MADE
)
'-
"' —
EACH OCCURRENCE
AGGREGATE
DED RETENTION
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR /PARTNER /EXECUTIVE
OFFICER /MEMBER EXCLUDED?
(Mandatory in NH)
It yes, describe under
DESCRIPTION OF OPERATIONS below
Y / N
N I A
-
-: , .
- - - • � --• - • -
- -
. _ ..._ ,.
- - - . .. - _.. ,..,
WC STATU-
TORY LIMITS
OTH-
ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L DISEASE • POLICY LIMIT
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
CERTIFICATE HOLDER
CANCELLATION
344 -925 -3 4 0
CITY OF CLEARWATER
PO BOX 4748
CLEARWATER, FL 33758 -4748
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
(;-27#47
ACORD 25 (2010105)
O 1988 -2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
FEDERATED
/NSURANCEvm
To Whom It May Concern,
RE: FLORIDA AIR SYSTEMS INC
Enclosed is a certificate of insurance that has been renewed for a new policy term. If a copy
of an additional insured or policy endorsement was requested, the document will be sent in a
separate envelope.
If you have any questions regarding this please contact: the Federated Insurance Client
Contact Center at:
Phone: 1- 888 - 333 -4949
Fax: 507 - 446 -4664
E -mail: clientcontactcenter @fedins.com
Thank you,
Client Contact Center
Federated Insurance Companies
Enclosed:
Certificate of Insurance
MISC -0974 (04 -13)