CERTIFICATE OF LIABILITY INSURANCE (541)ACTI -11
OP ID: B8
ACORO-
`..� CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
10/28/2014
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: 813- 226 -1300
Brown & Brown of Florida, Inc. Fax: 813 - 226 -1313
P. O. Box 173086
Tampa, FL 33672
P
Steve Ayers
NAME: CT Bernadette Perreault
PHONE FAX '
(NC, No. Ext): 813 -472 -7022 (NC, No): 813- 226 -1313
E -MAIL
ADDRESS: bperreault@bbtampa.com
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A : Bridgefield Employers Ins.
10701
INSURED Action Air Conditioning, Inc.
David & Susan Russell
8926 N Armenia Ave
Tampa, FL 33604
INSURER a :AUTO OWNERS INSURANCE
18988
INSURER c : OWNERS INSURANCE COMPANY
32700
INSURER D:
$ 1,000,000
INSURER E :
$ 300,000
INSURER F :
$ 10,000
•
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
JNSR
JNSR
SUER
WVD
POLICY NUMBER
(MM/DD //YYYY)
(MM /DDIYYYY)
LIMITS
B
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
20676036
R.' „;� ,�
�(fa �* € R.
s�
'^eL c `° _
'�t'>
1/01/2014
�
_
11/01/2015
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 300,000
MED EXP (Any one person)
$ 10,000
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
POLICY
LIMIT APPLIES
PRO -
JECT
PER
LOC
Emp Ben.
$ Excluded
C
AUTOMOBILE
X
X
LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
Comp $250
X
SCHEDULED
NON -OWNED
AUTOS
%- ,
4112004'1t`''-"2 (`/ L `x '4'."J
• 1�0fd2/2014
10/02/2015
COMBINED SINGLE LIMIT
(Ea accident)
500,000
3
$
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA LIAB
EXCESS UAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
$
DED
RETENTION $
A
WORKERS COMPENSATION
AND EMPLOYERS' LABILITY
ANY PROPRIETOR/PARTNER /EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
Y/”
N
N / A
830 -34558
05/31/2014
05/31/2015
X
W MU- S
W-
E.L. EACH ACCIDENT
$ 500,000
E.L. DISEASE - EA EMPLOYEE
$ 500,000
E.L. DISEASE - POLICY LIMIT
500 000
$ ,
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required)
Re: David Carl Russell - License #CAC042730
V CRIIrIVAI C rlvLIJ r
CITYCLE
City of Clearwater
100 S Myrtle St
Clearwater, FL 33758 -4748
------- ••• —•-
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)
_2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD