CERTIFICATE OF LIABILITY INSURANCE (8)
08/31/2005 15:32
352- 343'-01 '34
CLARK SALES DISPLAY
PAGE 01/01
ACORQ'j CERTIFICATE OF LIABILITY INSURANCE
PRODJJCI;;R (407)886-3301 FA)( (407)886-95"30
I GENTRY :tNSUlMT\ICE; AGENCY, Ii'JC.
I 175 East. ;~ai" Street
. "'\ Box 2046
~~OPKA, FL 32701-2046
/INSURED Clark Sales Display Inc
POBox 1007
I Tavares, Fl 32778
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COVERAGES
I iHE POl/CIES OF iNSURANCE L!STEb BELOW HAVE BEEN rSSUlOD TO THE INSURED NAMED .A,SOVE !"OR TH!;; POLlCY PE;R10D INDICATs;l, NO I vViTHSTANDrNc.:;
J ANy REQUiREMENT, TERM OR COND!TION OF NJY CONTRACT OR OTHER DOCUMENT WITH RE;SPECT iO WHICH THIS CERTIFICATE MAy BE ISSu>=D OR
MAy PERTA!N< Tj.IE; INSIJi'tAJ,jCE AFFbRDED ~v THE PCUGIEo OESCRIBED HEREIN IS 8U8._I!:C'T TO ALL TH!: TER',1S< E;XCLUSIONS AND CONDITIONS OF SUCH I
~OLtCI~S< AGGREGATE: LIMITS SHOWN MAY HAVE BEEN RGDUC~D BY PM:: C.lAIMS I
-~b!;l'~ rYPEOI"MSUAANC" I POUCVNUMElER I POlJcY_El'~~!.'llVE IPOI.IC"ihlIP,RATION' - LiMns -J
lT~ _NSR_ - < - I OJ\n; lMM/lJlJlTY I !;lATE IMMlDOIYY . . J
! j GENIORAI.l.IMluty I "i 2012 710292/ 08/01/2006 ! 08/01/2007 i :~:~~~~~:::~~~ I.~ 1,000 t 000/
i ~ ""l"""'''''''''''''^,.U''-BIJl'\ .! i I I.PREM'S.~.~.E.1.i ,.!J.c;ureoc~j 1$ .. 100,0001.
i J CLAIMS MADE. W OCCURl I i I MEDl:M'(i\iiYOooversonj l~,-_ lO,OQQj
I A X I - ! i i j F'ERSOl'",1.&AiN iNJURY I $ 1,000,0001
I W . .' .. I I I ~LAG(;Fil:i5l\1EJ5 2,000,0001
I IGEN<LAG!",lR.!i<GAfE.lI.MI.T AI'PI.!ESl'E!<..j ,I IPROOUCI8-0:;MPiOPMG1~ . 7 OOo~ooo.
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j I I I PDUCY 11 J"CT ! ! Lac j i I i I
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. AUTOMoallEUASIUTY I 4689364600, 08/01/2006 i 08/01/2007 I COMBfNED;SiNGI.EUMIT I,; J
I Ixl ANY AUTO I ,I I (Ea "",,.~,~t} 1 1. 000 000'
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I'. I I All OWNED AUTOS.. i I i OODIL Y J: IJWRY j I
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I' SCUE!"lUi ~h hi ITor-<, .- i"" "_'"''',' I
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III I, tKI HIRED AUToS , I I I I ~p~ILYj'J,I~~RY Is I
I Xl NON-OV.'NEDAU'!'OS I '! i \, '0, "',","'lI'\'1 . ~ I
I I r, t I I .!:,~?R:RJY,l(^MAGE I $ I
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,._n-j-, I 16A.QA,GIH-tABllItY AI)TO ONL II _ f'A ".CCIDENT I $ j
I I JlH ANY AUro 'OTHERTfillN EA~:CG-li l;S ---J
f #\UTO ONt'''-; "._ I
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H E)(CE8SIIJM~aLALtABlL;iY I 2072710292, 08/01/2006 , 08jOl/2007 I E:ACHOCCURRENCE 1$ ,2.000,0001
/1 I f!J oOC'~ 0 C~'"' """ I I; I ,,"'....""'" i ~ ' . 000 ..Q!l!Jj
A I X h . ' j r0110lAls f"orm I ~ J
1'1 ' 1-. I DEDUGTIai.E I I '. I ~,_~__J
,---, nr""L"'<~H ,.. I I I' $ ---.
--H ! i n,r,''''''iV''. .' I j I ,v'\,j~iAI\J- i 10TH' I
I ~'tOI'lKER.S CpMPENSAilON AND I I --1 TORY LIMITS I I ER f _~_
I;MI'LOYERS Ll/\,IlIUTY J I EL EACH ACClOENT ! $ - II
(I\NY oR.OPRlF.TOF~/I"ARTN"RlEXF.ClJTIVE I l~~~,~_
'I Ol"ngp/MEMS. .t:R EXGLVr.::!:Dt I. i I!IH, DIS~":5E _ EA E'MPLO,(E~ $ I
I yr<<, de=iJ:1" under I. ~, ,~o '. i '"'4
11;PEC~\L PROVISiONS bcloYi j I I E"L, DISE:A!lrs _ p,-,,-,,,, I ~IM" i $ I
OnlER ) i I I
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fOESCR.'l'T'ON OF l;lPt;P'.ATlOi'45 J LOCATIONS IVEHlCLE31 E<CLlJSfONS AtlDEO Di ENDOR5~Mj;;n j .9PEClAL PROVISIONS I
E: Holiday Decorating Services I
ity .,Of Clearwa't~t' is inc1ud~d as Additional Insul"~d on ~nera-! Liability and Auto LiabiHty. I
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r10 day, oo'ice al1...d fOr ...-pa....., ,. day, notice al!-..d for all ethor r...on.. I
CERTltiCATE HOLDER CANCELLATION
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I 01' ANY klNn ~'PON THE INStJRi:n, ITS ACl",NT;< <;)R Rj]f'R[!SIONTATI\lE~,
I AIfTHOl'UlED '<<:PRES9ITATNE; &~k&1._ d",~~r.>tk-
I Debra LiebJ(oecht/DAWN
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! INSU~ERS AFFORDING COVERAGE
II.NSURER ~,;
IINSLIRER Sr
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UAI"'I!\lMlDOIYYYY) I
08;0312000 I
T IS CERT FICATE I Issueo AS A MAnER Of' ."FORM .ION I
ONLY AND CONFERS NO RIGHTS UPON THE cERTIFICATE I
HOLDER THiS CERTIFICA 1E OOI:S NOT AMEND, EXTEND OR j
AL TE~ THE COV/':RAGE Af'!"'OROEO "Y THE POLICIes BELOW. I
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Vall~y For9~ Insurance Co./O~A
Auto-Owners Ins Co
City of Clearwater
Attn: Debbie Reid
PO 80x 4748
Clearwater, Fl 33758-4748
l>HOULO AI'O-i OF THE ABOve OE9CRlBHl !'OUCIIOS BE; CANCELLED BE'I'o~e!HE
EXPiRATiON OA,TI; 'tHEReOF. THE ISSUING 1N'!lU~"R WlLl. ENDIOAVO~ 1'0 r~l\!!.
~ !:lAYS WRiTTEN NOTICE: TO THe CE~nFrCATE ~LO"ll NAMED TO nm LeFT,
BUT 1"A1I.URE TO MAIL SUCH NOTlCe SHALL IMPOSE NO OBlIGATION OR UAS1llTY
ACORIJ25 (2001/08) FAX; (727) 562-482 5
@ACOROCORPORATfON1988
U~[Ul[LUUb UO:44
:3':lL-:34:j-[11 '34
CLAF~I< SALES DI:=;F!LA\/
PAGE 02/02
Certificll1e ofTflsurance
Telis certificate is jgSIled.as a matter ofirtfonnatlon only and confers no rights upl)f1 the Ccn:ificm.te Hulder other than these provirlw by thi~ policy.
Tbi's ccr.titicate does not amend, extend, or alter the coverage ilfforded by tbe policies rle,;cribcd herein.
Named InsIIred(s):
r-.:-. .
I~{~:ity HR, ln7a~~ its wholly ?WnM sUbsidiaries, including but not
I !1m. l:ed t? r:::l~ J:IR, L~;, ~:e.-"'tty ~!: U'.,~~; Gevlty HR I., n, L:';
GeVlty HR 'v, LP, Gevu} DR V, LX, O"Vlty HR VI, l.P, Gevlty
I fiR vII, 1.1'; Gevity l-iR VIII, L?;o..".'jty fIR IX, LP; Gevity HR X,
'r n n 't HR X" L+ C G ' 'Tn 'VII r<
I JJ:'; '.TelI'1 "'J - , _l,. L'; ev1ty.r:'i1'.. ," J uorp.
I 600 301 Bouiev~td West
Bfooenwu, Fl(lftda 34205
IV1ARSH
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I Insurer Affording Coverage t
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American flome ^s.<;ur1\n~e Co., I
Member of AmericA1l1Dwrthitlfllinl GI'r,IlP, 1..~. (AlG) I
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"rhis is to certify that the policy(ies) or insut'dtlce described, hErein have been iS$led to the insured !'I.lmed herein for the pQlicy pc~iod indicated. I
N01~ithstan~lng 9nY requirement, tenn o~ c~d1r.ion o~ any i:on!m~{ or <;ther document with r~ to which tbe 9erttfi<)ate may ~ i~<:lled or \1iay I
pertain. the m;;urancc afforded by the pdlcy(les)descl'lbed herem IS subject to all the terms, cond\oons tmd exolUSJOns of such pohCY(lCS). I
(Aggr;:gare) Limits shown may have been N"duQed by -paid claims.
~ e of Insunmee Certill.cate E . Date
I Worl<:ers' 1-1.-2007
I Compensation
COveraga~:
R..l\-JWC94U92i
RM'VC9431313
Limits
Em (oyers UabUi
Bodily Tl'\lll!y By ^reidcnt
$ 2,000,000
Each Accident
PoIicv Number
Bcd-a:), ~ury Ply f}1~~
$l~OOO,OOO
!'olic)' Urnll
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I Ot~er:
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Bo<llly Injury l'I;\' I)l~c
$ 2,000.000
I2nch Pcrsoo
Emp'oyees Lelllled To;
Effective Date: 1fli06
10181 Clark Saf~ DIsplay Inc.
ThcabtOYc TJ;tcr"llc:cd worker,,' oornpcn~tiM' polic)'(,<!jl) provi,to{~) RtlltulOry hllllc1illi only ,\Hhc cmpll;')"'"'!\ of the NIIIMd TnlJJtr:li(R) on IIUch p<)lIc"j(ic~). 11M to the cmplQy~ {If any tltln:r
employer.
NQt1ce Or Cancellation: Should any oftbe policies described herein be cancelled before the expiration date thereof, the insurer
r.ff.Jrding coverage wlll endeavor to mail 30 days written notice m trn; ~fiC6te h<:lldo.r rlllmOO nl}rl;lin~ but failure to mail such notice
shall in'plJ8C no obligaHon or !lability of 8UY kind upon the \n~\trer .,ffbtding WV(lrngli>, its a.gel'lts <)t'representatives,
Certifil;llt.e Holder:
City of Clearwatst
PO Box 4748
Cloorwser, Fl 337$4748
. .v7. . '1. /~ ,$ /J. /,-7 /. .I .'
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Michael C. Weiss
Antbmi7..ed Representative \'if Marsh USA lli~,
(866) 443~~-489
.Phone
12n,~2005
Date: Issued