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CERTIFICATE OF LIABILITY INSURANCE (479)
1 6 A CERTIFICATE OF LIABILITY DATE (MM /DDIYYYY) INSURANCE 1 6/30/2014 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 Adcock Adcock Insurance Agency Ta TaW. mpa Fletcher -34. Tampa FL 33612 -3414 NAME: Radha Jones (A /C, "No. Ext):813 933 6691 (a/c, No):813- 932 -6287 E-MAIL Ss:radha adcock- insurance.com 1� INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Owners Insurance Co 32700 INSURED 70 Smith & Hudson Interiors Inc 5003 N. 40th St. #101 Tampa FL 33610 -5237 INSURER B Auto-Owners Insurance Co 18988 INSURERC: INSURER D : EACH OCCURRENCE INSURER E : DAMAGE TO PREMISES (Ea occurrence) INSURER F : MED EXP (Any one person) COVERAGES CERTIFICATE NUMBER: 860612608 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 NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 20663654 7/1/2014 7/1/2015 EACH OCCURRENCE $500,000 DAMAGE TO PREMISES (Ea occurrence) $50,000 MED EXP (Any one person) $5,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $500,000 GENERAL AGGREGATE $1,000,000 PRODUCTS - COMP /OP AGG $1,000,000 GE X 'L AGGREGATE POLICY LIMIT APPLIES PRO- JFCT PER LOC $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS 9541917800' 7/1J2014 7/1/2015 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 9541917801 7/1/2014 7/1/2015 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 $ DED X RETENTION $10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y /" N / A WC STA f I TORY I TU- I I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ 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 Clearwater FL 34237 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 RE PR $F.NTATIVE ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD