CERTIFICATE OF LIABILITY INSURANCE (606)CERTIFICATE OF LIABILITY INSURANCE
OP ID: SE
DATE (MMfD0,rn
02122/12
flS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,
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 T- E ISSUING INSURER(SI, AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollty(Iesy must be endorsed, If SUBROGATION 15 WA
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certtfl &ate does not con
ale holder In Ileu of such endorsement(s).
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Insurance Agency
nsportation
2430 West Oakland Park Blvd.
Ff, Lauderdale, FL 33311
aNSuaE0 T_ Wayne Hill Trucking, Inc.
595 West Summerlin Street
Bartow, FL 33830
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954.7
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ACT
RERESSER
CUSTOMER ID
HILTWOS
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INSURERA AFFORDING COVERAGE
R A at Divide Ins. Co,
WSURER B Commerce & Industry Ins Co
NaLRER C Nautilus Insurance Co.
0
OVERAGES
CE
TIFICATE NU
BER:
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN I TO THE INSURED
INDICATED- NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CtOCUMENT
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEC
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
..., ..._ .
NAM ED ABOVE FOR THE POLICY
WITH RESPECT TO WHICH
HEREIN IS SUBJECT TO ALL THE
PERIOD
THIS
TERMS,
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30 days notice of cancellation, crcept 10 days for non payment of premium,
subject to the terms, conditions and exclusion of the policy.
CERTIFICATE HOLDER
CANCELLATION
City of Clearwa
100 S. Myrtle Ave..
Clearwater, FL 33756
Floor
CITCLD5
ACORD 25 (2009/09)
SHOULD ANY OF THE ABOVE O!SCRIBED POI-ICI 5 BE CANC
THE EXPIRATION DATE THEREOF, NOTICE WILL
ACCORDANCE WITH THE POLICY PROVISIONS.
EKED IN
19 -2009 ACORD CORPORATION. All righte reserved,
The ACORD name and logo are registered marks of ACORD