CERTIFICATE OF LIABILITY INSURANCE (291)AccRO®
L.----- CERTIFICATE OF LIABILITY INSURANCE
DATE (MM /DD/YYYY)
2/12/2014
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
Lassiter -Ware Insurance of Tampa Bay
4401 West Kennedy Blvd
Suite 200
Tampa FL 33609
CONTACT Jude Sutton
(A/C, )_ (800) 845 -8437 I ( , No): (888)883-8680
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A Allied Property & Casualty
42579
INSURED
Cass Plumbing, Inc.
5555 West Linebaugh Avenue
Suite C
Tampa FL 33624
INSURER B :FCCI
GLP03006463563
INSURER C :
1/9/2015
INSURER D :
$ 1,000,000
INSURER E :
$ 100,000
INSURERF:
$ 10,000
CERTIFICATE NUMRFR•14 -15 Cart
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
SUER
WVD
POLICY NUMBER
(MM/DDY/YYYY)
(MMIDD/YYYY)
LIMITS
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
GLP03006463563
1/9/2014
1/9/2015
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 100,000
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:
7POLICYIXIJ P- IILOC
A
AUTOMOBILE
X
X
LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
X
SCHEDULED
AUTOS
NON -OWNED
AUTOS
BAPC3006463563
1/9/2014
1/9/2015
(Ea accidentSINGLE LIMIT
)
_$___- 500 000
$
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
(Per
PIP -Basic
$
A
X
UMBRELLA UAB
EXCESS UAB
X
OCCUR
CLAIMS -MADE
CAP3006463563
1/9/2014
1/9/2015
EACH OCCURRENCE
$ 2,000,000
AGGREGATE
$ 2,000,000
$
DED I
RETENTION$
B
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
NIA
001WC14A67842
1/9/2014
1/9/2015
X I TORY L MITS I
OER
E.L. EACH ACCIDENT
$ 1,000,000
$ 1,000,000
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
A
LEASED /RENTED EQUIPMENT
CIMP3006463563
1/9/2014
1/9/2015
!EASED /RENTED EQUIPMENT $50,000
DESCRIPTION OF OPERATIONS / LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
A_ F{ Z
GEKTIFIUAIE r'IULL' K
City of Clearwater
100 S. Myrtle Ave.
Clearwater, FL 33756
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• A„iVE S `ICS Dr°)
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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
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ACORD 25 (2010/05)
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