CERTIFICATE OF LIABILITY INSURANCE (651)'' 7 � DATE (MMIDDNYYY)
A� Ro CERTIFICATE OF LIABILITY INSURANCE
O6/10/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVE�Y 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 SUBROGATION IS WAIVED, sub�ect 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
ce�[ificate holder in lieu of such endorsement(s).
PRODUCER NAME: ELIZABETH VALIENTE
Affordable Insurance Of Florida, Inc PH�E 813) 414-9655 FAX (813) 217-5313
ac No eM :( ac No :
3030 N Rocky Point Dr Suite #150 no�Ress: ELIZABETH@GMAIL.COM
INSURER(S) AFFORDING COVERAGE NAIC #
Tampa FL 33607-7200 iNSURERA: FEDERATED NATIONAL
INSURED. INSURER B :
INSURER C : '
MORALES CUSTOM FLOORING INSURERD:
12707 N OLA AVE INSURER E:
TAMPA FL 33612-4175 INSURER F:
rn�i�onr_cc f`FRTIFI(:oTF NIIMRFR• REVISION NUMBER:
..... �..r..��� --- - - -- - -- - - — - - ----- -- ..
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 REDUIREMENT, 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 POLICV EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIVYVY MMlDD/VYYY
COMMERCIAL GENERAL UABILITY EACH OCCURRENCE g �,OOO,OOO
CLAIMS-MADE � OCCUR PREMISES Eaocc�uece $ �OO,OOO
MED EXP (Any one person) g 5,000
q GL-0000028755-00 O6/06/2015 O6/O6/ZO'IF) pERSONAL&ADVINJURY $ 2�000,000
GEN'LAGGREGATELIMITAPPLIESPER: . GENERALAGGREGATE $ Z,OOO,OOO
❑ PR0. ❑ PRODUCTS-COMP/OPAGG $ �,OOO,OOO
POLICY JECT LOC
$
OTHER:
AUTOMOBILE LIABILITY Ea accidenl I $
ANY AUTO BODILY INJURY (Per person) $
ALLOWNED SCHEDULED BODILYINJURY(Peraccident) $
AUTOS AUTOS —
NON-OWNED PR PERTY DAMAGE $
HIREDAUTOS AUTOS Peraccident
$
UMBRELLALIAB OCCUR EACH OCCURRENC-. $
EXCESS LIAB CLAIMS-MADE AGGREGATE S
DED RETENTION $ a
WORKERS COMPENSATION P H
STATUTE ER
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N� A E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L. DISEASE - EA EA9F'LOYE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLIC;" LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER IS LISTED UNDER THE GENERAL LIABILITY POLICY AS AN ADDITIONAL INSURED.
CERTIFICATE HOLDER CANCELLATION
CITY OF CLEARWATER
PO BOX 4748
CLEARWATER, FL 33758
ACORD 25 (2014/01)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIE'� BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE YIILL BE DELIVERED �N
ACCORDANCE WITH THE POLICY PROVISIONS.
AU7HORRED REPRESENTATIVE
�Gia..�er� C, ✓aL�eHre
Glizabeih ��. Valiente i.:w�. �0. 2�N5j
OO 1988-2014 ACORD
The ACORD name and logo are registered marks of ACORD
f8S@rV@CI.
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