CERTIFICATE OF LIABILITY INSURANCE (370)JACKJ -3
OP ID: KW
4 QY
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIYYYY)
03/18/2014
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. It 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 Phone: 727 -4474481
Bouchard - Clearwater FaX' 727-449-1267
101 Starcrest Drive
P 0 Box 6090
Clearwater, FL 33758 -6090
Nicholas Amaro
NAMEACT
PHONE FA No):
(ArC, No Exll:
E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC if
INSURER A: FCCI Commercial insurance Co
33472
INSURED Jack Joyner Enterprises Inc
dba Jack Joyner Heating & Air
Conditioning Company
1860 N Hercules Avenue
Clearwater, FL 33765
INSURER B: National Trust Insurance Co
20141
INSURER C : Bridgefield Employers Ins Co
10701
INSURER D:
X
INSURER E:
DAMAGE IORENTED
PREMISES (Ea occurrence)
INSURER F:
MED EXP (Any one person)
•
a.v V IrwGES ..�........,, . � •..,.... �...
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 )NSR
ADDL SUBR
WVD
POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYYI
LIMITS
A
GENERAL LIABILITY
X
CPP0010017
`77, �/" -"
-
04/01/2014
04/01 /2015
EACH OCCURRENCE
$ 1,000,000
X
COMMERCIAL GENERAL LIABILITY
DAMAGE IORENTED
PREMISES (Ea occurrence)
$ 100,000
MED EXP (Any one person)
$ 5,000
CLAIMS -MADE I X I OCCUR
PERSONALS ADV INJURY
$ 1,000,000
LIMIT APPLIES PER:
GENERAL AGGREGATE
f 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
GEM. AGGREGATE
—1 POLICY n .78TT ^ LOG
Emp Ben.
f 1,000,000
B
AUTOMOBILE UABILITY
CA0013467
Y ,.;y , ..,- ,, r „,.Yi
,)4/01/2014
. ... /
04/01/2015
(EaaBciden[) INGLE LIMIT
f 1,000,000
X
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
—
—AUUTOS
SCHEDULED
OS
NON-OWNED
AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
f
f
/\
X
UMBRELLA LIAB
EXCESS LIAB
DED X RETENTION
X
f
OCCUR
CLAIMS -MADE
10,000
UMB0008800
04/01/2014
04/01 /2015
EACH OCCURRENCE
f 5,000,000
AGGREGATE
f 5,000,000
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNERID(ECUTNE YtN
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N I A
83029095
04/01/2014
04/01 /2015
X
ORSTATUS OTH-
TORY LIMITS ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
f 1,000,000
E . DISEASE - POLICY LIMIT
S 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Addilional Remarks Schedule, if more space is required)
JOB NAME: CITY OF CLEARWATER MAIN LIBRARY, 100 N OSCEOLA AVE., CLEARWATER,
FL. CERTIFICATE HOLDER IS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY,
ONLY IF REQUIRED BY WRITTEN CONTRACT, AND SUBJECT TO THE TERMS, CONDITIONS
AND LIMITS AS SPECIFIED IN THE POLICY.
GCNi it R.M I c rfOLIJCrc
CITYCLW
CITY OF CLEARWATER
P O BOX 4748
CLEARWATER, FL 34616 -4748
...- .....--.._._
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
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ACORD 25 (2010/05)
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The ACORD name and logo are registered marks of ACORD