CERTIFICATE OF LIABILITY INSURANCE (619)���_ti�s� ����� DATE�MM/DD/YYVY)
, CERTIFICATE OF LIABILITY INSURANCE d/1d/7(11.ri
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 tNSURED, 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
.ykes Insurance, Inc.
'. O. BOX 2879
"ampa FL 33601-2879
INSURED
Connor's Jet Age Fuel, Inc.
Aaron
519 Pennsylvania Ave
Clearwater FL 33755
COVERAGES
CONNE-3
CERTIFICATE NUMBER: A78042112
PHONE
INSURER B :
INSURER D :
INSURER E :
AFFORDING COVERAGE
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.
INSR TVPE OF INSURANCE A�� B POLICY NUMBER MM/DD/YEYYY MM/ D/VYYY LIMITS
LTR
A GENERAL LIABILI7Y Y EGGCD000032715 /15/2015 /15/2016 EACH OCCURRENCE $2,000,000
X DA A E T RENTED
COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence 5100,000
CLAIMS-MADE � OCCUR MED EXP (Any one person) $NONE
PERSONAL & ADV INJURY $2,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $2,000,000
X POUCY PR� LOC $
A AUTOMOBILE LIABILITY Y EAGCD000032715 i15i2015 i15/2016
Ea accident $2 000,000
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE
X HIRED AUTOS X AUTOS Per accident $
PIP S$10,000
A X UMBRELLA LIAB X OCCUR EXAGD000032715 115/2015 /15/2016 EACH OCCURRENCE $3,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000
DED X RETENTION$10,000 $
q WORKERS COMPENSATION EWGCD000032715 /15/2015 /15/2016 X wC STATU- OTH-
AND EMPLOYERS' LIABILITY Y/ N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? � N � A
(Mandatory in NH� E.L. DISEASE - EA EMPLOYEE $1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 701, Additional Remarks Schedule, if more space Is required)
Certificate holder is listed as additonal insured for GL per form CG2010 & Auto Liability; 30 days notice of cancellation included except 10
days for non-payment
CERTIFICATE HOLDER
City of Clearwater
Box 4748
Clearwater FL 33758
ACORD 25 (2010I05)
CANCELLATION
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
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O 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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