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CERTIFICATE OF LIABILITY INSURANCE (11) ACORDm CERTIFICATE OF LIABILITY INSURANCE OP ID COATE (MM/DDIYYYYI PICKL-l 04/16/07 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. F;';RODUCER Bouchard-Clearwater 101 Starcrest Drive POBox 6090 Clearwater FL 33758-6090 Phone:727-447-6481 Fax: 727-449-1267 INSURED INSURERS AFFORDING COVERAGE NAIC# Pickles Plus Inc & Pickles Plus Too Kim Benedettini Blazakis PO Box 308 Fox River Grove IL 60021 INSURER A: INSURER B: INSURER C INSURER D INSURER E: Travelers Property Cas of Amer COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TI-E 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSRD TYPE OF INSURANCE POLICY NUMBER I'D').~ (MMlDDNY) -~kt'E' (MMlDDNYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 f-- 03/23/07 03/23/08 A ~ COMMERCIAL GENERAL LIABILITY I6804638A922PHX07 PREMISES (Ea occurence) $ 300000 o CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5000 f-- PERSONAL & ADV INJURY $ 1000000 f-- ~ LIQUOR LIABILITY GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2000000 n n PRO- nLOC LIQ LIAB 1,000,000 POLICY JtC I AUTOMOBILE LIABILITY ~ I....CElVEl ) COMBINED SINGLE LIMIT f-- (Ea accident) $ ANY AUTO f-- ALL OWNED AUTOS A ~~ BODIL Y INJURY f-- j '( 2007 $ SCHEDULED AUTOS (Per person) I-- HIRED AUTOS BODIL Y INJURY f-- OFFICI) l RECORDS A (Per accident) $ NON-OWNED AUTOS \JD - lEG/SLA - riVE SRVCS Of PT PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONL Y - EA ACCIDENT $ =j ANY AUTO OTHER THAN EA ACC $ AUTO ONL Y: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ ::J OCCUR D CLAIMS MADE AGGREGATE $ $ =j DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND IT6~'y t:~I~~ I IU~~ EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ OFFICERlMEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below EL DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES J EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS FAX: 727-562-4825 CERTIFICATE HOLDER CANCELLATION CITCLEA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN CITY OF CLEARWATER ATTN: KEVIN DUNBAR 100 SOUTH MYRTLE AVE CLEARWATER FL 33756 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHOR PR SENTA @ACORD CORPORATION 1988 ACORD 25 (2001/08) ........~.... .. I....'........... ..... I....., I 1111 I ~~..... "- ......1 " IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) ACORDN CERTIFICATE OF LIABILITY INSURANCE OP 10 C~ DATE (MM/DDNYVY) PICKL-1 12/03/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Bouchard-Clearwater ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 101 Starcrest Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR POBox 6090 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Clearwater FL 33758-6090 Phone: 727-447-6481 Fax: 727-449-1267 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Travelers Property Cas of Amer -- Pickles Plus Inc INSURER B: & .l?ickles Plus Too Inc. INSURER C: Kim Benedettini Blazakis PO .Box308 INSURER 0: Fox River Grove IL 60021 INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSRI TYPE OF INSURANCE POLICY NUMBER PDA~E MM/DD,iy{' p~kW(,,~!,IRA TION LIMITS LTR DATE MM/DDlYYl GENERAL LIABILITY EACH OCCURRENCE $ 1000000 - 03/23/07 PREMISES (Ea occurence) A X X COMMERCIAL GENERAL LIABILITY I6804638A922PHX07 03/23/08 $ 300000 I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5000 PERSONAL & ADV INJURY $ 1000000 - ~ LIQUOR LIABILITY GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2000000 ~ n PRO- nLOC LIQ LIAB 1,000,000 POLICY JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I--- $ ANY AUTO (Ea accident) I-- ALL OWNED AUTOS BODILY INJURY I--- $ SCHEDULED AUTOS (Per person) I-- . HIRED AUTOS BODILY INJURY I--- $ NON~OWNED AUTOS (Per accident) I-- I--- PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ R ANY AUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ o OCCUR D CLAIMS MADE AGGREGATE $ $ R DEDUCTIBLE $ RETENTION $ $ -_._~- ---_...-- .... - ITO~Y:S~(~WS I IOIfF ~-=--'"'""- -woRKERs-cOllllPEI\fSATrOl\i AND - ER EMPLOYERS' LIABILITY ANY PROPRIETORlPARTNERlEXECUTIVE EL. EACH ACCIDENT $ OFFICERlMEMBER EXCLUDED? EL. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ATTN: PAM ATKINS, CITY ATTY - CERT HOLDER IS AN ADDITIONAL INSURED REGARDING LOCATION AT 320 CLEVELAND ST, CLEARWATER, FL, SUBJECT TO THE TERMS, CONDITIONS AND EXCLUSIONS OF THE POLICY. CERTIFICATE HOLDER RECEIVED CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHOR EP SENTA - - - -@ACORDCORPOAATIOfi.r 198"8- CITY OF CLEARWATER 112 OSCEOLA AVE CLEARWATER FL DEe 0 6 2007 ~ITY ATTORNEV ACORD 25 (2001/08)