CERTIFICATE OF LIABILITY INSURANCE (609)�� ��`���°��h 9f CONST-1 OP ID: AC
'4�� °� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDM'YV)
03/03/2015
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/s1.
PRODUCER
West Coast Insurance, Inc.
8377 Gunn Highway
Tampa, FL 33626
GEORGEtACKEY
INSURED CONSTRUCTION EQUIPMENT INC
& PAUL G WERDER
711 JEFFORDS ST
CLEARWATER, FL 33756
iNSUReRn:OWNERS INSURANCE COMPANY
iNSUreeR e: MAXUM INDEMNITY COMPANY
iNSUReRC:BRIDGEFIELD INS CO
E:
10701
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. NOTWITHSTANDlNG AR�Y 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 L U R
� TYPE OF fN$URANCE POLICY NUMBER MMlDDY� MM/DD/YYYY LIMITS
OENERAL LIABILITY EACH OCCURRENCE $ 'I,OOO,OO
B X COMMERCIAL GENER,4L LIABILITY DBG3005042-02 03/03/2015 03/03/2016 DAMA E T REN ED
PREMISES Eaoccurrence $ ��0,0�
CLAIMS-MADE � OCCUR MED EXP (Any one person) $ �,OO
PERSONAL & ADV INJURY $ 'I,OOO,OOO
GENERALAGGREGATE $ Z,OOO,OO
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ Y,OOO,OOO
POLICY PR� LOC g
AUTOMOBILE LIABILITY COMBINED SING�E LIMIT
Ea accident � ,���,�0
A X ANY AUTO 4131312101 � 03/17/2015 03/17/2016 BODILY INJURY (Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY (Per accident) $
HIRED AUTOS NON-OWNED PROPERTY DAMAGE
AUTOS PERACCIDENT $
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCE33 LIAB CLAIMS-MADE
AGGREGATE $
DED RETENTION $
WORKERS COMPENSATION X WC STATU- OTH-
AND EMPLOYERS' LIABILITY
C ANYPROPRIETOR/PARTNER/EXECUTIVE Y�N 830-35488 01/01/2015 01/01/2016 E.L.EACHACCIDENT $ ���,0�0
OFFICER/MEMBER EXCLUDED? � N / A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1 ��,�0
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ $OO,OO
DESCRIPTION OF OPERAl70NS / LOCATONS ! VEHICLES (Attach ACORD 101, Addidonal Remarks Sohsduls, If more spacs Is rsquired)
GENERAL LIABILITY POLICY ABOVE APPLIES TO DOOR INSTALLATION OPERATIONS ONLY.
CITY OF CLEARWATER
PO BOX 4748
CLEARWATER, FL 33758-4748
ACORD 25 (2010/05)
CITYCLE
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
�
O 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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