CERTIFICATE OF LIABILITY INSURANCE (31)
A COROTM
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDNYJ
1/05/07
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
Acardia Southeast. Inc.
P.O. Box 31666
Tampa, FL 33631-3666
727-796-6666
INSURERS AFFORDING COVERAGE
INSURED
Image One
Image One Corp dba
6206 Benjamin Rd #301
Tampa FL 33634
COVERAGES
INSURER A:
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
HARTFORD INSURANCE GROUP
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.
I~: TYPE OF INSURANCE POLICY NUMBER ':.~!;!2Y EFFECTIVE POLICY EXPIRATION LIMITS
A GENERAL LIABILITY 21 SBALl1614 1/01/07 1/01/08 EACH OCCURRENCE $ 1000000
f--
X COMMEflCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone firel $ 300000
I CLAIMS MADE W OCCUR MED EXP (Anyone person) $ 10000
PERSONAL & ADV INJURY $ 1000000
GENERAL AGGREGATE $ 2000000
GEN'L AGGREFl LIMIT APPl PER: PRODUCTS - COMP/OP AGG $ 2000000
n POLICY ~Wi- LOC
A AUTOMOBILE LIABILITY 21 UECLl4905 1/01/07 1/01/08 COMBINED SINGLE LIMIT
f-- $ 1000000
~ ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
f-- $
SCHEDULED AUTOS (Per person)
I--
~ HIRED AUTOS BODILY INJURY
$
~ NON-OWNED AUTOS (Per accident) ...
f-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A EXCESS LIABILITY 21SBALl1614 1/01/07 1/01/08 EACH OCCURRENCE $ 1000000
:1sj. OCCUR 0 CLAIMS MADE AGGREGATE $ 1000000
$
=j DEDUCTIBLE $
X RETENTION $ 10000 $
A ' WORKERS COMf'eI.SATIONANI)-. - . 2 lWia)USSl1 . .. -l/Ol/07 liD 1/08. JTVX~iT~~~;,! . .IOl~-
EMPLOYERS' LIABILITY --_...
E.L. EACH ACCIDENT $ 1000000
E.L. DISEASE - EA EMPLOYEE $ 1000000
E.L. DISEASE. POLICY LIMIT $ 1000000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER IS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF CLEARWATER DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -1Q.. DAYS WRITTEN
ATT: CITY CLERK NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
POBOX 4748 IMPOSE NO OBUGATlON OR UABIUTY OF ANY KIND UPON THE INSURER. ItS AGENTS OR
CLEARWATER FL 337584748 REPRESENTJldlvES. /?
AUT~ "' PREuf,I,..TI'Iot/ w/
I "'1/"7
ACORD 25-S (7/97) 45- 38 . t/ V , @ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 26-5 (7/971