Loading...
CERTIFICATE OF LIABILITY INSURANCE (396)Ae Ith° CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 10/2/2013 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 Jack Rice Insurance 13080 S Belcher Rd Largo FL 33773 CONTACT Commercial Lines Division NAME: PH NWo )_ (727) (A FAX /C Not :(727)532 -9602 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER AAuto- Owners Ins. Co. 18988 INSURED Randy Eggers Roofing, LLC 394 Ulelah Avenue Palm Harbor FL 34683 INSURER B Bridgefield Employers Ins. Co. 10701 INSURERC: 10/1/2014 INSURER D : $ 300 , 000 INSURER E : $ 50 000 INSURERF: $ 5, 000 COVERAGES CERTIFICATE NUMBER:CL1310231571 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 ADDU INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MMIDD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY RECEIVED 2058051513 FEB f ? -re}� r'y ��a'u'I�e.cF:Lr�iaOe�9 10/1/2013 e4 + 10/1/2014 EACH OCCURRENCE $ 300 , 000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 50 000 MED EXP (Any one person) $ 5, 000 CLAIMS -MADE I I OCCUR PERSONAL 8 ADV INJURY $ 300 , 000 GENERAL AGGREGATE $ 300 , 000 PRODUCTS - COMP/OP AGG $ 300 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: X 1 POLICY n jE n LOC $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS '�e g v s�� 9671150000 VJ (MJ ( 10/1/2013 10/1/2014 COMBINED SINGLE LIMIT (Ea accident) 500 000 BODILY INJURY (Per person) —$ $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Commercial Auto Plus Package $ UMBRELLA UAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENT ON $ B WORKERS COMPENSATION AND EMPLOYERS' UABIL TY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N I A 083024670 3/1/2014 3/1/2015 WC STATU- I I OTH- X TORY UMITS ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION (727) 726 -2228 City of Clearwater 100 South Myrtle Avenue Clearwater, FL 33756 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 Cynthia Webster /LPW fin . t .t� ACORD 25 (2010/05) INSO25 /9ninnst ni © 1988-2010 ACORD CORPORATION. All rights reserved. Theo A('ARfl name Snell Innn sra ranietororl marks of ArtARfl COMMENTS /REMARKS AUTOMOBILE LIABILITY Scheduled Additional Insureds for Lessors per form 19020 10/80. OFREMARK COPYRIGHT 2000, AMS SERVICES INC.