CERTIFICATE OF LIABILITY INSURANCE (2)AWRL7 CERTIFICATE OF LIABILITY INSURANCE
�"'�
DATE (MM /DD/YYY17
12/31/2014
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 No.: (212) 488 -0200
Fax No.: (212) 488 -0220
Frenkel & Company
350 Hudson Street — 4th Floor
New York, NY 10014
CoI'ITACT
PHONE
(NC, No, Ed): (AC
E -MAIL
ADDRESS:
PRODUCER
d1Sf0NHtD
INSURER(S) AFFORDING COVERAGE
NAJC #
INSURED
Polydyne Inc.
One Chemical Plant Road
PO Box 250
Riceboro GA 31323
Cf1VFPAGFS neerrorwry
INSURER Al AIG SPECIALTY INSURANCE COMPANY
26883
INSURER B: COMMERCE & INDUSTRY INSURANCE COMPANY
19410
INSURER C: HARTFORD INSURANCE COMPANY OF THE MIDWEST
37478
INSURER D:
DAMAGE TO RENTED
PREMISES (Ea occurrence)
INSURERS:
INSURER F:
_— _
CLAIMS MADE
•
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
W VD
POLICY NUMBERDIYYYYI»
POLICY EFF
POLICY EXP
urS
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
X
EG14362834
12/31/2014
12/31/2015
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 500,000
CLAIMS MADE
X
OCCUR
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 5,000,000
GEN'L AGGREGATE
POLICY
LIMIT APPLIES
PRO-
JECT
PER:
LOC
PRODUCTS- COMP /OP AGG
$ 2,000,000
$
B
AUTOMOBILE
X
LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
X
AUTOSULED
NON -OWNED
AUTOS
X
CA4691818
12/31/2014
12/31/2015
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
A
X
UMBRELLALtAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
EGU18403155
12/31/2014
12/31/2015
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
DED I I RETENTION $
$
C
WORKERS COMPENSATION
AND EMPLOYERS' UABIUTY Y/ N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
It yes tlescribe under
DESCRIPTION OF OPERATIONS below
N/A
1 OWNR30600
12/31/2014
12/31/2015
X
TORY LAM TS I I ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE- EA EMPLOYEE
$ 1,000, 000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space H required)
City of Clearwater is included as Additional Insured as required by contract and subject to the policy terms conditions and exclusions.
90 DAY CANCELLATION CLAUSE INCLUDED
City of Clearwater
100 S. Myrtle Ave.
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
P
1
ACORD 25 (2010/05)
88 -2010 ACORD COR RATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD