CERTIFICATE OF LIABILITY INSURANCE (2)
A CORD_
CERTIFICATE OF LIABILITY INSURANCE
OP 10 DI DATE (MM/DD/YYYY)
UPARC-1 11/30/06
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
Bouchard-Clearwater
101 Starcrest Drive
P 0 kox 6090
Clearwater FL 33758-6090
Phone: 727-447-6481 Fax: 727-449-1267
INSURERS AFFORDING COVERAGE
James River Insurance Co
NAIC#
10335
10120
12203
INSURED
UPARC Inc
Sheldon Hershman
1501 North Belcher Road
Clearwater FL 33765-1302
INSURER A:
INSURER B
INSURER C.
INSURER D
INSURER E:
Bridgef'ield Casualty Ins Co
Everest National Insurance Co
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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 POLlCIE:i 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 ~~~MMIDOIYY)- DATE IMMlDfiiYW LIMITS
GENERALLIABILrTY EACH OCCURRENCE $1000000
- 12/01/06 12/01/07 ~~~~~s YE~~d';'~nce)
B X COMMERCIAL GENERAL LIABILITY CAOOOO0257061 $100000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5000
10 DAY CllNC FOR NONPAY PERSONAL & ADV INJURY $1000000
GENERAL AGGREGATE $2000000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2000000
I nPRO- n Emp Ben. 1000000
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1000000
-
B X ANY AUTO CAOOOOO137061 12/01/06 12/01/07 (Ea accident)
-
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
- ..-
X HIRED AUTOS BODILY INJURY
- $
...!.. NON-OWNED AUTOS (Per accidenl) --
10 DAY CANe FOR NONPAY PROPERTY DAMAGE
- $
(Per accident) :
GARAGE LIABIlITY AUTO ONLY - EA ACCIDENT $ - -
=i ANY AUTO OTHER THAN EAACC $
-- AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY 12/01/06 i EACH OCCURRENCE $1000000
C ~ OCCUR D CLAIMS MADE 00013102 12/01/07 AGGREGATE $1000000
10 DAY $
:=l DEDUCTIBLE CANC FOR $
X RETENTION $0 NONPAYMEN $
WORKERS COMPENSATION AND X I TORY LIMITS I IU1H-
ER
A EMPLOYERS' LIABIlITY 019603019 04/01/06 04/01/07 $1000000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? 10 DAY CllNC FOR NONPAY E.L. DISEASE - EA EMPLOYEE $1000000
If yes, describe under E.L. DISEASE - POLICY LIMIT $1000000
SPECIAL PROVISIONS below
OntER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
fax #799-9960
--
CERTIFICATE HOLDER CANCELLATION
CLWRFIR SHOULD ANY OF ntE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIl. -~ DAYS WRITTEN
CLEARWATER FIRE DEPT
NOTICE TO ntE CERTIFICATE HOlDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHAll
IMPOSE NO OBUGATION OR LlABlLrTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
ACORD 25 (2001/08)
@ ACORD CORPORATION 1988