CERTIFICATE OF LIABILITY INSURANCE (25)
ACORDN CERTIFICATE OF LIABILITY INSURANCE OP ID P~ DATE (MMIDDIYYYY)
UNIVENG 07/10/06
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
J Rolfe Davis Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 945255 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Maitland FL 32794-5255
Phone:407-69l-9600 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Amerisure Mutual Ins. Co. 23396
INSURER B:
Universal Engineering Sciences I INSURER C:
Inc.
3532 Magrie Blvd. INSURER D:
Orlando L 32811
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.
LTR NSRC TYPE OF INSURANCE POLICY NUMBER PD9f--/~iJ~rJ~~E P~k~CEY(~~b~J!,~N LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
- ~REMISES (Ea occurence)
COMMERCIAL GENERAL LIABILITY $
I CLAIMS MADE D OCCUR MED EXP (Anyone person) $
1-----.
PERSONAL & ADV INJURY $
-
GENERAL AGGREGATE $
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG $
'I n PRO. nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- (Ea accidenl) $
ANY AUTO
-
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
HIRED AUTOS BODILY INJURY
- $
NON.OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
, (Per accident)
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
=1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
=:=J OCCUR D CLAIMS MADE AGGREGATE $
I
I P DEDUCTIBLE $
$
I RETENTION $ I $
I WORKERS COMPENSATION AND X ITORYLIMITS I IUJ~'
A EMPLOYERS' LIABILITY WC200~65604 01/0),.lOJi. 01/Q11.07 $lDOOOOO
. ANYPROPRjETOf1/PA~rNER/EXECU'rIVE..- E'J" EAGttACCIDEI'H._ .
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1000000
If yes, describe under , E.L. DISEASE - POLICY LIMIT $ 1000000
SPECIAL PROVISIONS below
~ OTHER
I
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Workers Compo policy includes a blanket waiver of subrogation in favor of
the certificate holder if required by written contract. *Except as required
by Florida Statute. RE: LaBella Vista Condominiums, Clearwater, Florida
Requestor Fawn Foremanj7-10-06
CERTIFICATE HOLDER
CANCELLATION
CITYCLE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10* DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
City of Clearwater
Attn: Robbie Ackerman
100 S. Myrtle Avenue #210
Clearwater FL 33756
@ ACORD CORPORATION 1988
ACORD 25 (2001/08)