CERTIFICATE OF LIABILITY INSURANCE (218)DATTI
ACORDTM CERTIFICATE OF LIABILITY INSURANCE
07/31/2013)
PRODUCER
Ashbrook - Clevidence, Inc.
3000 W. MacArthur Blvd., #320
License #0188788
Santa Ana, CA 92704
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
Data Ticket, Inc. dba: Revenue Experts
4600 Campus Drive #200
Newport Beach, CA 92660
INSURER A: State Compensation Ins Fund
INSURER B:
GENERAL
INSURER C:
_-,
INSURER D:
-
INSURER E:
$
VER
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
r r•
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM /DDIYY)
POLICY EXPIRATION
DATE E (MMIDD/YY)
LIMITS
GENERAL
LIABILITY
COMMERCIAL GENERAL LIABILITY
_-,
...___......
-
EACH OCCURRENCE
$
■
DAMAGE TO RENTED
• 11 , -
$
��
CLAIMS MADE OCCUR
MED EXP (Any one person)
$
■
PERSONAL & ADV INJURY
$
■
GEN'L
GENERAL AGGREGATE
$
AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG
$
■
AUTOMOBILE
POLICY ■ JET ■ LOC
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
_.
, _
COMBINED SINGLE LIMIT
(Ea accident)
■
BODILY INJURY
(Per person)
■
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(Per accident)
$
GARAGE
LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
■
OTHER THAN EA ACC
$
AUTO ONLY: AGG
$
EXCESS
/UMBRELLA LIABILITY
OCCUR n CLAIMS MADE
DEDUCTIBLE
RETENTION $
EACH OCCURRENCE
$
■
AGGREGATE
$
$
■
$
■
$
A
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER /EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
S AL PROVISIONS below
90657312013
07/12/13
07/12/14
X MEM GS
E.L. EACH ACCIDENT
$1,000 ,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
E.L. DISEASE - POLICY LIMIT
$1,000,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
CERTIFICATE HOLDER
CANCELLATION *10 Days for Non- Payment
City of Clearwater
P.O.Box 4748
City of Clearwater, FL
33758 -4748
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *40 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001/08) 1 of 2
#S25328/M25308
SXL
0 ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 -S (2001/08) 2 of 2 #S25328/M25308