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CERTIFICATE OF LIABILITY INSURANCE
AC 0» AMBIT-2 OP ID: OW1 �.....� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/18/2014 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. If SUBROGATION IS WAIVED,subject to the terns 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 CONTACT Wasson Bay Area Insurance NAME: Odessa Winters 9067 Belcher Road PHONE 727-544-8841 Pinellas Park FL 33782 a/c Mo.Ext FAX N,I:727-544-8842 n-DMRa ss:Odessa wassonba area.com INSURERS AFFORDING COVERAGE NAIC# INSURED Ambition Skate LLC INSURER A:Western Heritage Ins.Co. 37150 Jason Broyles INSURER B: 1426 S Martin Luther King Jr A INSURER C: Clearwater,FL 33756 INSURER D: INSURER E: INSURER F 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 DDL B LTR TYPE OF INSURANCE POLICY NUMBER MM/DD�Y MWDDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRE"$ 1,000,00,00 CLAIMS-MADE �OCCUR X TBD 07/18/2014 07/18/2015 PREMISES Ea N ,00 MED EXP(Any on ,00 PERSONAL&AD ,00 GEN'L AGGREGATE LIMIT APPLIES PER:POLICY❑PRO ❑ GENERAL AGGR00 JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,00 i OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE $ Per accident UMBRELLA LIAB OCCUR EXCESS LU1B CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY Y/N STATUTE ER H ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) City Of Clearwater is listed as additionalinsured with respects to the General Liability CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS. 100 S Myrtle Ave Clearwater,FL 33756 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD