CERTIFICATE OF LIABILITY INSURANCE (7) CERTIFICATE F LIABILITY I DATE Ofn_ )
TU 02/06/2015
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 SUORMAUTOR 15 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 holler in lieu of such endomement(s).
PRODUCER
NAME:
Alley, Rehbaum A Capes Assurance, Lac. "°NN E,, 727.797.5193 ,-727.725.5773
2433 Gulf to Bay Blvd. ADDRESS:h
P.O. Box 4620 INSURER(S)AFFORDING COVERAGE NAIC#
Clearwater, FL 33758 ----------------------_�__---..^.-------___.._.__._. �____—.
INSURER A: Philadelphia Indemnity Ins Co
INsuRED Artx 4 L1 fe Aced y Inc INSURER s: Progressive Express 10193
2751 Kings Highway INSURER C:
Clearwater, FL 33755 INSURER D:
INSURER E: —
INSURER F
COVERAGES CERTIFICATE NUMBER: 14/15 Lib and Auto 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.
IMM LTA TYPE OF INSURANCE INSR V VD POLICY NUMBER LIMITS
GENERAL UABRAY PHPKI 1631 1010112014 1010112015 EACH OCCURRENCE S 11000,000
X OOMM£RC€AL GENERAL LIAStLrrY PREMISES oocurrencs S 300,00rd
_...
CLAIMS.MADE X 1 OCCUR MED E(P(Any cm pamm) $ S'00
A PERSONAL S ADV INJURY $ 1,000,00
GENERAL AGGREGATE $ 3,000,00
GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 3,000,00
X 1 POLICY PRO-
ECTT LOC
AUTOMOBILE LIABILITY 03389473C 1210112014 1210112015 Ea accident $ 1100010
ANY AUTO SODILY INJURY(t-r pown) $
B ALL OWNED X SCHEDULED
AUTOS AUTOS BODILY INJURY(Per sccideni) $
HIRED AUTOS
NON-OWNED eRt $
$
UMBRELLA LUIB OCCUR EACH OCCURRENCE $
EXCESS LIAR HCLAIMS-MADE AGGREGATE $ �.----
DED I I RETENTIONS 1$
WOPJCERS COMPENSATION
WC STATU-
AND EMPLOYEIM L€ANLO Y YIN TORY LO TTS ER
ANY PROPRIETORIPARTNEMEXEC E,L EACH ACCIDENT $
OFFICER�,tEMBFR EXCLL>I'I£67 ��� NIA
(M-4—.7 In NN) E.L.DISEASE-EA EMPLOYEE $
It�e dcacrlba under ....---------'"----
DESI {r IPTION OF OPERATIONS blow E.L DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS/VEWLES(Attach ACORD 1$1,Addiliareai Remarks Schedule,If MGM apace Is required)
Certificate Holder is Additional Insurance
Location: 1751 Kings Highway, Clearwater, FL 33755
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE sF.
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISI
City of Clearwater AUTHORIZED REPRESENTATIVE
100 S. Myrtle Avenue
L—.01arwater. FL 33756 Signature on file w Carriers
0 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(201WOS) The ACORD name and logo are raglatemd marks of ACORD
i