Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
CERTIFICATE OF LIABILITY INSURANCE (312)
Client#: CERTFOU ACORDT. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 3/07/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER - Lanier Upshaw, Inc. 1115 US Hwy 98 South P.O. Box 468 Lakeland, FL 33802 CONTACT Darlene Koesel PHONE FAX (NC, No, Ext): 863 686 -2113 (AC, No): 863 682 -6292 AD AIL SS: darlene.koesel @lanierupshaw.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: First Specialty Insurance Corp 34916 INSURED Certified Foundations Inc 1306 Banana Road Lakeland, FL 33810 INSURER B : Bridgefield Employers Ins Co 10701 INSURER C : Westfield Insurance Company 24112 INSURER D : $1,000,000 $50,000 $10,000 $1,000,000 INSURER E INSURER F : CLAIMS -MADE COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NU rk -�( POLICY EFF DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY IRG2000928 ii tt .., n $ ' � i- ...+ /..:�. «a.5^v s',. a 8/2014 _• + �. 03/08/2015 EACH OCCURRENCE $1,000,000 $50,000 $10,000 $1,000,000 PREMISES (Ea RENTED CLAIMS -MADE X OCCUR MED EXP (Any one person) X BI /PD Ded:5,000 PERSONAL & ADV INJURY GENERAL AGGREGATE $2,000,000 Per Claim PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES JECT PER: LOC $ C AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X _ SCHEDULED AUTOS NON OW AUTO-S NED CMM7493913 03/08/2014 03/08/2015 (E° aBccl eDtSINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A x UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE IRE200029301 03/08/2014 03/08/2015 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DED X RETENTION $0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) — — - If yes, describe under DESCRIPTION OF OPERATIONS below N / A 83052378 03/08/2014 03/08/2015 X WC STATU- TORY LIMITS OTH ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION City of Clearwater P 0 Box 4748 Clearwater, FL 34618 THE SHOULD EXPIRATION DATE V THEREOF, E NOTICE WILL BE ACCORDANCE WITH THE POLICY PROVISIONS. DELIVERED IN AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) 1 of 1 itA9dfQ5Q /M9dfQc9 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Rf1K