Loading...
CERTIFICATE OF LIABILITY INSURANCE (264)HAMJ -01 OP ID: LS AFRO" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 01 /06/2014 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: 863-967-4454 Mulling Insurance Agency, Inc. Fax: 863 - 967 -7592 P 0 Box 308 208 E Park Street Auburndale, FL 33823 -0308 Mark E. Spann, CIC CONTACT NAME: PHONE FAX (A/C. No, Ext): (A/C, No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: General Ins. Co. of America 24732 INSURED J H Ham Engineering, Inc. Sandra Olive P O Box 5106 Lakeland, FL 33807 -5106 INSURER B : Landmark American Ins Co 01C1518271 -3 LHR742881 INSURER C : Bridgefield Employers Ins. Co. 10701 INSURER D : $ 1,000,000 INSURER E : $ 200,000 INSURER F : COVERAGES 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 WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A B GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 01C1518271 -3 LHR742881 12/31/2013 12/31/2013 12/31/2014 12/31/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 200,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 X Professional Liab GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE 7 POLICY LIMIT APPLIES PRO PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 PROF LIAB $ $1M / $2M A AUTOMOBILE X X UABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X _ X SCHEDULED AUTOS NON -OWNED AUTOS HIRED PD 24CC31028510 12/31/2013 12/31/2014 COMBINED SINGLE LIMIT (Ea accident) J 1,000,000 $ BODILYINJURY(Perperson) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ HIRED PD $ 50,000 A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 01SU429074 -2 12/31/2013 12/31/2014 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X RETENTION $ 10000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A 0830 -33032 01/01/2014 01/01/2015 X W TMU 0R - E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 A Equipment Floater 01C1518271 -3 12/31/2013 12/31/2014 Rent/Leas 100,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule If more space Is required) Engineers CERTIFICATE HOLDER CANCELLATION CITYCLE City of Clearwater P.O. 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 111#F- ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD