CERTIFICATE OF LIABILITY INSURANCE (214)OP ID: KW
---- ACORO*
`,,.•,� CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDVWW)
07/29/2013
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: 727-447-6481
Bouchard - Clearwater Fax: 727 -449 -1267
101 Starcrest Drive
P 0 Box 6090
Clearwater, FL 33758 -6090
Nicholas Amaro
CONTACT
FAX No):
(7/42.141, Ext):
(MM% POUCY EXP
.
E-MAIL DRESS:
PRODUCER ENGLA -1
CUSTOMER ID#:
INSURER(S) AFFORDING COVERAGE
INSURER A : Amerisure Mutual Insurance Co
NAIC #
23396
INSURED England Brothers Const Co Inc
Marsha England
12255 75th Street North
Largo, FL 33773
INSURER B:Amerisure Insurance Company
19488
INSURER C : FCCI Insurance Co
10178
INSURER D:
07131/2013
INSURER E :
EACH OCCURRENCE
INSURER F :
1,000,000
•
VISION NUMBER:
vTHIS 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.
ILTR
TYPE OF INSURANCE
ADDL
SUBR
POLICY NUMBER
(MM /DD /D/YYYY)
(MM% POUCY EXP
LIMITS
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL
LIABILITY
X
OCCUR
GL2088626 ;
,
07131/2013
07/31/2014
EACH OCCURRENCE
$
1,000,000
DAMAGEIO
PREMISES (Ea occurRENrED rence)
$
100,000
CLAIMS -MADE
MED EXP (Any one person)
$
5,000
PERSONAL & ADV INJURY
$
1,000,000
GENERAL AGGREGATE
$
2,000,000
GEN'L
X
AGGREGATE LIMIT
APPLIES PER:
LOC
PRODUCTS - COMP /OP AGG
$
2,000,000
POLICY JEEC
T
Emp Ben.
$ 1,000,000
B
AUTOMOBILE
X
UABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
CA2002045' ". " `
-
07/31/2013
07/31/2014
COMBINED SINGLE LIMIT
(Ea accident)
$
1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
$
A
X
UMBRELLA UAB
EXCESS LIAB
X
OCCUR
CLAIMS-MADE
CU2001045
07/31/2013
07/31/2014
EACH OCCURRENCE
$
1,000,000
AGGREGATE
$
1,000,000
X
DEDUCTIBLE
RETENTION $ 0
$
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE YI❑N
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
It yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
03034
01/01/2013
01/01/2014
X ATU- OTH-
TORT IMITS ER
E.L. EACH ACCIDENT
$
100,000
E.L. DISEASE - EA EMPLOYEE
$
100,000
E.L. DISEASE - POLICY LIMIT
$
500,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required)
CICLEAR
CITY OF CLEARWATER
PO Box 4748
Clearwater, FL 33756
I
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
ACORD 25 (2009/09)
The ACORD name and logo are registered marks of ACORD