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CERTIFICATE OF LIABILITY INSURANCE (414)
CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 11/20/2013 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 Jensen & Jensen Insurance P.O. Box 935 5845 Main St. New Port Richey, FL. 34652 CONTACT NAME Karen V. Lauinger (AH/C;N4 Fxq.727$42 -5705 FAX Nol: 7274424918 E -MAIL prep ADDRESS: nPr@paulferyaro.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Ohio Security LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Clearwater Window & Door, Inc. & Larry Focke 1414 South Missouri Ave. Clearwater FL 33756 INSURER B : Associated Industries Ins. Company BZS55809413 y /3 I. s 1 _., _� INSURER C : 11/09/14 INSURER D : $1,000,000 INSURER E : $ 300,000 INSURER F : f CLAIMS -MADE CERTIFICATE 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 ADDLSUBR INSR. WVD POLICY NUMBER POLICY EFF IMM /DD/YYYY1 POLICY EXP IMM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY BZS55809413 y /3 I. s 1 _., _� 11/09/13 ' 11/09/14 EACH OCCURRENCE $1,000,000 DAMAGE PREMISES S ( RENTED Fa occurrence) $ 300,000 f CLAIMS -MADE X OCCUR MED EXP (Any one person) $15,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE X POLICY LIMIT APPLIES PER: PRO- n LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON-OWNED AUTOS Y (, i P:1.,. q P t= (O accident) INGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) ( ) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAR EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N OFFICER/MEMBER EXCLUDED? ECUTIV� (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A AWC1022808 07/19/13 07/19/14 X WC STATU- TORY I NITS OTH- FR E.L. EACH ACCIDENT $100,000 E . DISEASE - EA EMPLOYEE $100,000 E . DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION City Of Clearwater 100 S. Myrtle Ave Second Floor Clearwater, FL 33756 -552 I Fax: (727)934 -4447 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 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD