CERTIFICATE OF LIABILITY INSURANCE (20)
AQDR~M CERTIFICA TE OF LIABILITY INSURANCE Page 1 of 2 I DATE
05/01/2006
PRODUCER 877-945-7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Willis North America, Inc. - Regional Cert Center HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
26 Century Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. O. Box 305191
Nashville, TN 372305191 INSURERS AFFORDING COVERAGE NAIC#
INSURED Retail Construction Services, Inc. INSURER A: Zurich American Insurance Company 16535-000
11343 39th St N INSURER B: St. Paul Fire and Marine Insurance Compan 24767-001
Lake Elmo, MN 55042
INSURER C:
INSURER 0:
I INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
['~f~ 1Ws~1 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE P8klfY EXPIRATION LIMITS
A GENERAL LIABILITY GL0380781602 5/1/2006 S/1/2()0? EACH OCCURRENCE $ 1,000,000
.. .- r-:::::: COMIvlERCIAL GENERAL LIABILITY --. ~ ---- ..' 8~~~H9E~~~J~~ncel
'x $ 300,000
I CLAIMS MADE [i] OCCUR MED EXP (Anyone person) $ 10,000
PERSONAL & ADV INJURY $ 1.000 000
-
GENERAL AGGREGATE $ 2 000 000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2 000 000
I POLICY !Xl jr8,: r=r LOC
A AUTOMOBILE LIABILITY BAP380781s02 5/1/2006 5/1/2007 COMBINED SINGLE LIMIT
- I (Ea accident) $ 1,000,000
ANY AUTO
- I
ALL OWN ED AUTOS BODIL Y INJURY
- (Per person) $
SCHEDULED AUTOS
r--
eX- HIRED AUTOS BODILY INJURY
(Per accident) $
rX- NON-OWNED AUTOS
- PROPERTY DAMAGE $
(Per accident)
! GARAGE LIABILITY AUTO ONL Y - EA ACCIDENT $
I h ANY AUTO
OTHER THAN EAACC $
. I AUTO ONLY: AGG $
B EXCESS LIABILITY QKOss01l22 5/1/2006 5/1/2007 EACH OCCURRENCE $ 10,000 000
~ OCCUR D CLAIMS MADE AGGREGATE $ 10 000,000
$
~ DEDUCTIBLE $
X RETENTION $ 10 DOC $
A WORKERS COMPENSATION AND WC380781702 5/1/2006 5/1/2007 X I r~f ~rAT~s I IOTH-
EMPLOYERS' LIABILITY T RY IMIT ER
. -- .. .- ..... E.L. EACH ACCIDENT -' i 500 000
ANY PROPRIETOR/PARTNER7EXECUTIIIE:'
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 500 000
If yes, describe under
, SPECIAL PROVISIONS below EL. DISEASE - POLICY LIMIT $ 500 000
I OTHER
I
I
DESCRIPTION OF OPERA TlONSlLOCA TIONSlVEHICLESlEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS RECEIVED
For Permit and License Purposes
RECEIVED 0 .~ ""IOt'
,.1 I; '!
, . 2005 Finance nnF'\'~j<i''''''\Ol1t
.
CERTIFICATE HOLDER
CANCELLATION
.~~dC1J\L RlC.~'kuv f\r~
"EGISLATIVE SRVCS DEP
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILLlCQfil~X1ll:MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEF1lUDilIIIK~L
~XIK~iW(16J[XlXIIOC'K'B:l6lIj{ICiJmC~X~ltKXllClXil.<<ilmC
~~x X
o
City of Clearwater
100 S. Myrtle Avenue
Clearwater, FL 33756
ACORD 25 (2001/08)
Coll:1614699 Tpl:493111
@ ACORD CORPORATION 1988