CERTIFICATE OF LIABILITY INSURANCE (621)SENTRY SELECT INSURANCE COMPANY ���
STEVENS POINT, WISCONSIN
(A PARTICIPATIN6 STOCK COMPANY)
A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES
• CERTIFICATE OF INSURANCE ACCOUNT NUMBER 49-82070
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This certificate is issued as a matter of information only and confers no
rights upon the certificate holder. This certificate does not amend,
extend or alter the coverage afforded by the policies below.
Name and Address of
Certificate Holder
CITY OF CLEARWATER
100 S MYRTLE AVE
CLEARWATER, FL 33756
Name and Address
of the Insured �
7 EVERGLADES FARM EQUIPMENT INC �"
PO BOX 910
BELLE GLADE, FL 33430
This certificate is issued on 04-01-2015 and is effective until
04-01-2016. It certifies that policies of insurance listed below have
been issued to the insured named above. 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 d�scribed hereiri is subject to all the terms, exclusions,
and conditions of such policies. Limits shown may have been reduced by
paid claims.
Coveraqe Provided
General Liabilitv
Bodily Injury and
Property Damage Combined
Policv Number Coveraae Limits
49-82070-21 General Aggregate S 1,500,000
Products Aggregate 5 1,500,000
OCCURRENCE Pers/Adv Injury S 500,000
Each Occurrence S 500,000
Premises Damage S 100,000
Medical Expense 5 5,000
Automobile Liabilitv 49-82070-21 Each Accident
Includes: Bodily Injury
and Property
Damage Combined
-Any Auto
Excess/Umbrella 49-82070-21 Each Occurrence
Liabilitv General Aggregate
Does Not Include: Products Aggregate
-Excess Employers Liab
ANNUAL EXPOS
$ 500,000
S 10,000,000
S 30,000,000
S 30,000,000
Should any of the above described policies be cancelled before the
expiration date thereof, notice will be delivered in accordance
with the policy provisions.
80-C1035 CMECH)
EVE 49-82070 01-015309
03-24-2015
PAGE 1
(0131)
LDI COI 269628-1 02 11
01T/80RG 0 2 5 5 5
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SENTRY SELECT INSURANCE COMPANY THE SENTRY PLAN
STEVENS POINT, WISCONSIN POLICY
(A PARTICIPATING STOCK COMPANY)
A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES
GENERAL LIABILITY DECLARATIONS
NAME INSURED: EVERGLADES FARM EQUIPMENT INC
ADDITIONAL INSURED
SCHEDULE
POLICY NUMBER 49-82070-21
The following information is required to complete the accompanying
additional insured endorsement which forms a part of the Named Insured's
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
ADDITIONAL
INSURED ENDORSEMENT EFFECTIVE
CITY OF CLEARWATER CG 20 10 04 13 FROM APRIL O1, 2015
100 S MYRTLE AVE TO APRIL O1, 2016
CLEARWATER, FL 33756
(CERTIFICATE NUMBER 0131)
LOCATIONCS) OF COVERED OPERATIONS
100 MYRTLE AVE
CLEARWATER, FL 33758
CG 89 O1 11 85 (MECH)
EVE 49-82070-21 40 151
03-24-2015
(000 0131)
FOR ENDORSEMENT TEXT.
SEE OVER.
01T180RG 0 2 9 3 6
POLICY NUMBER:
COMMERCIAL GENERAL LIABILITY
CG 20 10 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person{s)
Or Organization(s) Location(s) Of Covered Operations
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II - Who Is An Insured is amended to include as an additional insured the person(s} or
organization(s} shown in the Schedule, but only with respect to liability for "bodily injury", "property
damage" or "personal and advertising injury" caused, in whole or in party by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf;
in the performance of your ongoing operations for the additional insured{s) at the location{s} designated
a bove.
H oweve r:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance
afforded to such additional insured will not be broader than that which you are required by the
contract or agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusions
apply:
This insurance does not apply to "bodily injury" or "property damage" occuring after:
1. All work, including materials, parts or equipment furnished in connection with such work, on the
project (other than service, maintenance or repairs} to be pertormed by or on behalf of the
additional insured{s} at the location of the covered operations has been completed; or
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2. That portion of "your work" out of which the injury or damage arises has been put to its intended
use by any person or organization other than another contractor or subcontractor engaged in
performing operations for a principal as a part of the same project.
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CG 2010 0413 � Insurance Services Office, Inc., 2012 Page 1 of 2
01T18NRS
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POLICY NUMBER:
COMMERCIAL GENERAL LIABILITY
CG 20100413
C. With respect to the insurance afforded to these additional insureds, the following is added to Section III
- Limits Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will
pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
CG20100413
� Insurance Services Office, Inc., 2012
Page 2 of 2
07 T18N R2
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