CERTIFICATE OF LIABILITY INSURANCE (5)/ l � DATE (MM/DD/YYYY)
oR° CERTIFICATE OF LIABILITY INSURANCE �ni�ui�n��
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 INSURED, 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(sl.
PRODUCER
3reene-Hazel Insurance Group
10739 Deerwood Park Blvd Ste 200
Jacksonville F� 32256
INSURED
Northeast II, Inc. dba TC
Delivers; TC Specialties Co.
5911 Philips Hwy
Jacksonville FL 32216
COVERAGES
NORTH 18
CERTIFICATE NUMBER: 775511936
INSURER A
INSURER B
INSURER D
INSURER F
AFFORDING COVERAGE
REVISION NUMBER:
NAIC #
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTIMTHSTANDING 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 TypE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LIMITS
LTR IN R WVD POLICY NUMBER MM/DD/YYW MM/DD/YYYY
A GENERAL LIABILITY 01CI1084227 1/15/2015 1/15/2016 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY AMA E T RENTED
PREMISES Ea occurrence $1,000,000
CLAIMS-MADE � OCCUR MED EXP (Any one person) $10,000
PERSONALBADVINJURY $1,000,000
GENERALAGGREGATE $2,000,000
GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $2,000,000
POLICY PR� X LOC $
B AUTOMOBILE LIABILITY 810915K366315 1/15/2015 1/15/2016
Ea accident 1,000 000
%� ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTYDAMAGE $
HIRED AUTOS AUTOS Per accident
$
E X UMBRELW LIAB X OCCUR ZUP14P1458A15NF 1/15/2015 1/15/2016 EACH OCCURRENCE $5,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
DED X RETENTION $10,000 $
F WORKERSCOMPENSATION AWC1041708 12/31/2014 12/31/2015 X T RSTA IU- 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
C Prof Liability 03040680 8/14/2015 8/14/2016 Prof Liab Limit 3000000
� Crime 82095695 1/15/2015 1/15/2016 Crime Limit 1000000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, If more space is requlred)
City of Clearwater
100 South Myrtle Avenue
Clearwater FL 33756
ACORD 25 (2010/05)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORI2ED REPRESENTATIVE
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