CERTIFICATE OF LIABILITY INSURANCE (7)WINNI -1
OP ID: MH
A`WRV° CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDDIYYYY)
09/30/2014
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 Phone: 727-797-0441
HUB International Florida Fax: 727 - 669 -0673
CCF&N
P.O. Box 1027
Clearwater, Fn 33757
House ouse Account
NTACT
NA COME:
PHONE FAX
IOC. No. Extl: (ANC. No):
E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC If
INSURER A : Retail First Insurance Company
UABIUTY
COMMERCIAL GENERAL LIABILITY
INSURED Winning Inning Inc
Steve Chewcaskle
PO Box 15963
Clearwater, FL 33766
INSURER B : U.S. Fire Insurance Co.
USP130111
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RECEIVED
OCT O 3
INSURER C :
1010612015
INSURER D :
$ 1,000,000
INSURER E :
$ 300,000
INSURER F :
$ 5,000
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
INCR
SUBR
WVD
POUCY NUMBER
POUCY EFF
IMMIDDIYYYYI
POUCY EXP
IMMIDO/YYYYI
UNITS
B
GENERAL
X
UABIUTY
COMMERCIAL GENERAL LIABILITY
USP130111
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RECEIVED
OCT O 3
10/06/2014
2014
1010612015
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 300,000
MED EXP (Any one person)
$ 5,000
CLAIMS -MADE
X
OCCUR
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
GEN'L AGGREGATE LIMIT APPUES PER:
7 POLICY I- PF T LOC
$
AUTOMOBILE
UABIUTY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
_AUTOS
SCHEDULED
AUTOS
N -0
NON-OWNED
OFFICIAL RECORDS
1SLA SRVCS
—`� " – DEPT
DEP r
(�A�NEEDISINGLE UNIT
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
BODILY
$
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA UAB
EXCESS UAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
$
DED I RETENTION $
A
WORKERS COMPENSATION
AND EMPLOYERS' UABIUTY
ANY PROPRIETOR/PARTNER /EXECUTIVE Y / N
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
52043082
11/05/2014
11/05/2015
WC STATU- OTH-
TORY LIMITS I ER
E.L. EACH ACCIDENT
$ 500,000
E.L. DISEASE - EA EMPLOYEE
$ 500,000
E.L DISEASE - POLICY LIMIT
$ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space Is required)
CERTIFICATE HOLDER
CANCELLATION
i
CITY005
City of Clearwater
100 S. Myrtle Avenue
Clearwater, FL 33758
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
/l1 (1 .4.Ct-
ACORD 25 (2010/05)
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