CERTIFICATE OF LIABILITY INSURANCE (648)'`; a � CERTIFICATE OF LIABILITY INSURANCE DATEOH/ZF)I'I�)
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 certiflcate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and condltions of the policy, certafn policfes may require an endorsement. A statement on this certiflcate does not confer rights to the
certificate holder in Ifeu of such endorsement(s).
CONTACT
PRODUCER . Daniel COIuCCi
Colucci Insurance
1441 E. Fletcher Ave. Suite 105
Tampa, FL 33612
Phone (813)972-1947
INSURED
DIAMOND CORE DRILLING INC.
PO Box 1313
PORT RICHEY, FL 34673-
Fax (813)971-2787
(727)856-3977
(813) 972-1947-
dan@colucci-i nsurance.com
INSURER A : FUBA
INSURER B :
INSURER C :
INSURER D :
971-2787
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. 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.
INTR I TYPE OF INSURANCE Ii� a�wvn I POLICY NUMBER I!MM o�DYlWwI I(1YPtY�ooYlvvXVV1 I LIMITS
GENERAL LIABILITY
� COMMERCIAL GENERAL LIABILITY
❑ ❑ CLAIMS-MADE ❑ OCCUR
❑
❑
GEN'L AGGREGATE LIMIT APPLIES PER:
❑ POLICY ❑ jE� ❑ LOC
AUTOMOBILE LIABILITY
� ANY AUTO
ALLOWNED SCHEDULED
❑ AUTOS ❑ AUTOS
HIREDAUTOS NON-OWNED
❑ ❑ AUTOS
� UMBRELLA LIAB � OCCUR
� EXCESS LIAB ❑ CLAIMS-MADE
LJ DED LJ RETENTION$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/ N
ANY PROPRIETOR/PARTNER/EXECUTIVE 106-42804
A OFFICER/MEMBER EXCLUDED? N� A
(Mandatory In NH) �
If yes, describe under
EACH OCCURRENCE $
DAMAGE TO RENTED
PREMISES (Ea occurrenceL _ $
MED EXP (My one person) $
PERSONAL 8 ADV INJURY $
GENERALAGGREGATE $
PRODUCTS - COMP/OP AGG $
COMBINED SINGLE LIMIT
Ea accident
BODILY INJURY (Per person) $
BODILY INJURY (Per accident $
PROPERTY DAMAGE $
Per acciden1 _
$
EACH OCCURRENCE $
AGGREGATE $
E.L. EACH ACCIDENT
04/01/2015 04/01/2016 -- -
E.L. DISEASE - EA
E.L. DISEASE - PO
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is requlred)
CERTIFICATE HOLDER
CITY OF CLEARWATER LIBRARY SERVICES
1900 GRAND AVE
CLEARWATER, FL 33765
r-���t-_IVFU
ACORD 25 (2010/05) QF ��� U � "'"i4�
FfNA��10E DE='ca�' . °,r'��
CANCELLATION
$ 500,000.00 �
_ove $ 500,000.00 �
LIMIT $ 500,0�0.0�. _ I
1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AU7HORIZED REP�ENTATIV 1
/
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