CERTIFICATE OF LIABILITY INSURANCE (238)>
•
ACORQ, CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY) 9/05/2013
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
USI Insurance Services, LLC,
715 N. Westshore Blvd. Suite 700
Tampa, FL 33607
CONTACT
NAME:
PHONE g13 321 -7500 FAX
o, Ext >: (A/C, No):
813 321 -7525
E-MAIL
E -MA
ADDRESS:
INSURER(S) AFFORDING COVERAGE
_ NAIC #
INSURER A : Charter Oak Fire Insurance Comp
25615
INSURED
The Ash Group, Inc.
5802 Benjamin Center Drive #101
Tampa, FL 33634
INSURER B : Travelers Indemnity Company
25658
INSURER C : Travelers Casualty and Surety C
31194
INSURER D : Travelers Property Cas. Co. of
25674
INSURER E :
INSURER F :
X
E 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 POL CIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OF INSURANCE
INSR
WVD
POLICY NUMBER
(M A/DDY E/YYYYUMMM/DDDY/YYXYYL
05/16/2013
05/16/2014
LIMITS
EACH
$1,000,000
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
X
X
6801453M644
!
(OCCURRENCE
E
PREMISES (Ea occurrence)
$1,000,000
MED EXP (Any one person)
$10,000
$1,000,000
CLAIMS -MADE
X
OCCUR
PERSONAL & ADV INJURY
GENERAL AGGREGATE
$2,000,000
PRODUCTS - COMP /OP AGG
$2,000,000
$
GEN'L
X
AGGREGATE
POLICY
LIMIT APPLIES
JET
PER:
LOC
D
AUTOMOBILE
X
X
LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
X
SCHEDULED
AUTOS
NON WNED
AUTOS O
X
X
BA2,J83L240. .08/26/2013
08/26/2014
COMBINdED SINGLE LIMIT
$1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
B
X
UMBRELLA LIAB
EXCESS LIAB
_
OCCUR
CLAIMS -MADE
X
X
CUP9208Y682
05/16/2013
05/16/2014
EACH OCCURRENCE
$5,000,000
AGGREGATE
$5,000,000
$
DED
X
RETENT ON $10,000
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED? PROPRIETOR/PARTNER/EXECUTIVE
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
Y / N
N / A
X
U B3644T217
01/01/2013
01/01/2014
X
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 s required)
** Workers Comp Information **
USLH
CERTIFICATE HOLDER
CANCELLATION
City of Clearwater
100 South Myrtle Avenue
Clearwater, FL 34616
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
occ, �. Ots. -ot� ,tGL• ---
ACORD 25 (2010/05) 1 of 1
#S10900133/M10887587
®1988 -2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
LXGZP
USI INSURANCE SERVICES
CERTIFICATE RETURN MAIL PROCESSING
P.O. BOX 5007
NOVATO, CA 94948 -5007
CITY OF CLEARWATER
100 S MYRTLE AVE
CLEARWATER FL 33756 -5520