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CERTIFICATE OF LIABILITY INSURANCE (528)
A °V CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 9/18/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. HOLDER. THIS BY THE POLICIES AUTHORIZED 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 Lykes Insurance, Inc. P. O. Box 2879 Tampa FL 33601 -2879 CONTACT NAME: Tanya Russo PHONE FAX INC. No. Ext►:813 470 5022 lac, No):813- 221 -1857 ADDREss:trusso @lykesinsurance com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Evan stollll is CO 35378 18988 10701 23418 INSURED INNOV -9 Innovative Commercial Construc Mrs. Carol Petsch Saint 22nd Petersburg FL North, #338 Saint Petersburg FL 33710 INSURER B Auto-Owners Insurance INSURER c :Bridgefield Employers Ins Co. INSURER D Mid-Continent Casualty INSURER E :Underwriters at Lloyds y 15792 INSURER F : $100,000 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 LTR TYPE OF INSURANCE ADDL SUBR WVD POLICCYYNUNIRE POLICY EFF (MM /DD /YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X _,INSR LIABILITY COMMERCIAL GENERAL LIABILITY Y Y TBDLB2042pE� ��/ �� SEP �` RECORDS OFFICIAL RECORDS ' LEGISLATIVE SRVCS DEPT /17/2014 AND ° `D 8/17/2015 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $100,000 A } �JI _ CLAIMS -MADE X OCCUR MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENII AGGREGATE POLICY LIMIT APPLIES PRO- PER LOC PRODUCTS - COMP /OP AGG $2,000,000 $ B AUTOMOBILE X - =- X '1 X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS PIP $10,000 X SCHEDULED AUTOS AUTOS NON-OWNED AUTOS ED Y Y 4608117700 10/1/2014 10/112015 COMBINED SINGLE LIMIT (Ea accident) $1 000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) u yea, aoacribe under DESCRIPTION OF OPERATIONS below Y / N N / A Y 83035133 9/17/2014 /17/2015 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT I $1,000,000 L E Equipment Property 041M48717 438403 9/17/2014 2/16/2014 3/17/2015 2/16/2015 Limits Schedule on file Contents 20,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION 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 ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD