CERTIFICATE OF LIABILITY INSURANCE (220)ABSOL -1
OP ID: SD
'41`� °� CERTIFICATE OF LIABILITY INSURANCE
DATE(MM /DD/YYYY)
08/05/2013
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:941- 366 -8424
Atlas Insurance
PO Box 17669 Fax: 941 - 552 -4099
Sarasota, FL 34276 -0669
Thomas W. Kochis, CIC, CRM
NAME:
(aco,NN . Ext): FAX No):
E -MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A:FCCI Commercial Insurance
33472
INSURED Absolute Aluminum, Inc.
Absolute Aluminum &
Construction Company
Dale DesJardins
1220 Ogden Road
Venice, FL 34285
INSURER B :
GL00089285
#
INSURER C :
08/08/2014
INSURER D :
$ 1,000,000
INSURER E :
$ 100,000
INSURER F :
$ 5,000
COVERAGE
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
wvn
POLICY NUMBER
POLICY EFF
(MM /DD/YYYY)
POLICY EXP
(MM /DD/YYYY)
LIMITS
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
GL00089285
#
08/08/2013
08/08/2014
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
Contractual Liab
GENERAL AGGREGATE
$ 2,000,000
X
CXU Liability
PRODUCTS - COMP /OP AGG
$ 2,000,000
GE
'L AGGREGATE
POLICY
X
LIMIT APPLIES
IF -
PER
LOC
$
A
AUTOMOBILE
X
—
X
X
LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
$500 COMP
X
X
SCHEDULED
AUTOS
NON
AUTOS -OWNED
$500 COLL
CA00140335 -- - "'
-
08/08/2013
08/08/2014
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
(Paraccident) DAMAGE
$
$
A
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
UMB000089612
08/08/2013
08/08/2014
EACH OCCURRENCE
$ 2,000,000
AGGREGATE
$ 2,000,000
$
DED
X
RETENTION $ 10,000
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR /PARTNER /EXECUTIVE
OFFICER /MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
Y / N
N / A
001 WC13A38676
07/01/2013
07/01/2014
X
WC STATU-
TORY LIMITS
OTH-
ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
1 000 000
$ , ,
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
COVERAGE SUBJECT TO FORMS, CONDITIONS AND EXCLUSIONS.
I
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
omen `A✓• "/15-L.,p
ACORD 25 (2010/05)
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