CERTIFICATE OF LIABILITY INSURANCE (11)Acc•RD®
`� CERTIFICATE OF LIABILITY INSURANCE
DATE (MWDD/YYYY)
10/17/2013
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
Gentry Insurance Agency
175 East Main Street
PO Box 2046
APOPKA FL 32704 -2046
CONTACT Leslie Briante
NAME:
PHC °.No Extl: (407) 866 -3301 (A/c. Nol: (407) 666 -9530
MAIL Leslie@ ent ins.com
ADDRESS: g
INSURER(S) AFFORDING COVERAGE
NAIC #
INsuRERAAmerican Casualty Co of Readin
LIABILITY
COMMERCIAL GENERAL LIABILITY
INSURED
Clark Sales Display Inc
P 0 Box 1007
Tavares FL 32778
INSURER B :US Fire Insurance Company
20727
INSURER C:Southern- Owners Ins. Co.
10190
INSURER D:
8/1/2014
INSURER E :
$ 1 , 000 , 000
INSURERF:
$ 300 000
ster Auto 2013
REVISION NUMBER:
v
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
W VD
POLICY NUMBER
POLICY EFF
(MM /DD/YYYY)
POLICY EXP
(MM /DD/YYYY)
LIMITS
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
20727
+ ,vs • -,
OCT 21 2013
-�
8/1/2013
8/1/2014
EACH OCCURRENCE
$ 1 , 000 , 000
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 300 000
MED EXP (Any one person)
$ 10,000
CLAIMS -MADE
X
OCCUR
PERSONAL &ADVINJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP /OP AGG
$ 2,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
POLICY I E l TA I I LOC
$
B
AUTOMOBILE
X
X
LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
—
—
x
SCHEDULED
AUTOS
NON -OWNED
AUTOS
�i i: ^l RECORDS tN _.
LEMAPIE SRVrCSDEP'
133 - 734156 -3 10/21/2013
10/21/2014
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
$
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
PIP -Basic
$
C
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
4253955704 8/1/2013
8/1/2014
EACH OCCURRENCE
$ 3,000,000
AGGREGATE
$ 3,000,000
$
DED
X
RETENTION$ 5,000
WORKERS COMPENSATION
AND 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
WC
I TORY LAM - I I 10TH-
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)
RE: Holiday Decorating Services City of Clearwater is included as Additional Insured on General Liability
and Auto Liability.
. .II IV/11V IIV....--
(727) 562 -4825
City of Clearwater
Attn: Kyle Kilian
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
D Liebknecht /LESLIE
'21.--e,--1..-._
c;56:..-42 �' -4-"t___
ACORD 25 (2010/05)
INS025 (201005)01
_2010 ACORD CORPORATION. All rights reserved.
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