CERTIFICATE OF LIABILITY INSURANCE (10)
From: Rebecca Ambrose At: Bouchard Insurance FaxlD: Bouchard Insurance To: Debbie Reid
Date: 4/1912006 04:56 PM Page: 1 of2
ACORDN CERTIFICATE OF LIABILITY INSURANCE OP ID 1~ DATE (MMIDDIVYYY)
PICKL 1 04/20/06
PRDDUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
aouchard-clearwater ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
101 Starcrest Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
POBox 6090 AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater FL 33758-6090
Phone: 727-447-6481 Fax:727-449-1267 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A Travelers Property Cas of ber
INSURE~ B:
Pickles Plus Inc I NSURE.~ C
Kim Benedettini
PO Box 308 :NSURE~ D
Fox River Grove IL 60021
I NSURE~ E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PO~ICY P"RIOD INDICATED. NOTWITHSTANDING
ANY REr:lUIREMENT, TERM DR CONDITION OF A~IY CD~ TRACT DR OTHER DOCUMENT WITH RESPECT TO WHICH THI,S CERTIFICATE MAY BE LSSUEO 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 B"EN REDUCED BY PAID CLAIMS.
LTR NSRC TYPE OF INSURANCE POLICY NUMBER DATE (MM;DO,wt ~~kt'EY(MM/DDNY) LIMITS
GENERAL LIABILITY EACH OCCURR"NCE $ 1000000
f-- 03/23/06 03/23/07 ~=
A X COMMERCIAL GENERAL LIABILITY I6804638A922TIL06 PREMIS"S (Ea ocourence) $ 300000
- tJ CLAIMS MADE ~ OCCUR
MED EXP (Anyone person) $5000
-
PERSONAL & ADV INJURY $ 1000000
-
10 DAY BOTICE FOil 1I0K-EJAY GENERAL AGGREGATE $ 2000000
-
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2000000
Xl n PRO- nLOC
X POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- (Ea accident) $
ANY AUTO
-
ALL OWNED AUTOS BoalL Y IN,IURY
- (P.r p."onj $
SCHEDULED AUTOS
-
HIRED AUTOS BODIL Y INJURY
- $
NOr+OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONL Y - EA ACCIDENT $
=1 ANY AUTO OTHER THAN EA ACC $
AUTO ONL Y AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AGGREGATE $
$
=1 DEDUCTIBLE $
RETENT! ON $ $
WORKERS COMPENSATION AND ~sl 1~
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $
I r yes, describe under $
SPECIAL PROVISIONS below EL DISEASE - POLICY LIMIT
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
FAX: 727-562-4825
CERTIFICATE HOLDER
CANCELLATION
CITCLEA
SHOULD ANY OF TI1E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TI1E EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30
DAYS WRITTEN
CITY OF CLEAR~TER
ATTN: DEBBIE REID
100 SOUTH MYRTLE AVE
CLEARWATER FL 33756
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON TI1E INSURER, ITS AGENTS OR
REPRESENTATlVES.
AUTHOR PR SENTATI
@ACORD CORPORATION 1988
ACORD 25 (2001/08)