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CERTIFICATE OF LIABILITY INSURANCE (575)OP ID: WN '`��%"A CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DDmYY) 04/27/12 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 954- 792 -4300 Chase Insurance Agency Inc P O Box 17497 954 - 791 -9344 Plantation, FL 33318 -7497 MIKE CHASE .. CONTACT NAME: PHONE FAX (A/Q No, Est): (A /C, No): E -MAIL ADDRESS: PRODUCER ABCAU -1 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIL # , `' INSURED ABC T*ling St Recovery Ind `' Ii 4460 107 Circle North Clearwater, FL 33762.! 1 MAY Q 1 L s INSURER A :Nova Casualty CO 42552 INSURER B TIP -CL -0011410-0 I INSURER C : 04/30/13 .)NSURER D : $ 1,000,000 1 12v .._ _ _ : , - :r +INSURER E : $ 100,000 , INSURER F : CLAIMS -MADE • - - - - '- -- - --- - - -- - ---"' 1\L II 1V0.0111 1\U111117GR. 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 LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR TIP -CL -0011410-0 04/30/12 04/30/13 EACH OCCURRENCE $ 1,000,000 X DAMAGES ( PREMISES (Ea occurrence) RENTED $ 100,000 , CLAIMS -MADE X MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 3,000,000 POLICY PRO- JECT LOC $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS TIP -CL -0011410-0 04/30/12 04/30/13 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ X $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N N / A WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ below E.L. DISEASE - POLICY LIMIT $ A A ON HOOK & CARGO GKPR LEGAL LIAB TIP -CL- 0011410 -0 TIP -CL -0011410 -0 04/30/12 04/30/12 04/30/13 04/30/13 $1000 DED 100,000 $1000 DED 250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space is required) CERTIFICATE HOLDER CANCELLATION CLEAR01 City of Clearwater 1900 Grand Ave Clearwater, FL 33765 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 (2009/09) ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD