CERTIFICATE OF LIABILITY INSURANCE (658)�,..••� CUSSE-1 OP ID: EG
A �'o i7r�� DATE�MMIDDIYYYY)
��� "" CERTIFICATE OF LIABILITY INSURANCE
i�,,,.,�..--'' 09/08/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR 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 s.
PRODUCER CONTACT
NAME:
Huntleigh McGehee PHONE 314-746-4700 ac No : 314-889-3700
8235 Forsyth Boulevard, #1200 ac No ext :
Clayton, MO 63105 ADDR�ESS:
INSURED Customer Service
Associates, LLC
24807 E 101st Street
Lees Summit, MO 64086
INSURER A: A�lantic Specialty Ina. Co.
INSURER B: Travelers Prop & Caa of AM
INSURER C :
INSURER D :
INSURER E :
COVERAGE
54
74
q
OVERAGES 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.
�R TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MMIDD EXP LIMITS
R
X COMMERCIAL GENERAL LIABILITY EACH OCCURFENCE $ ��OOO�O
CLAIMS-MADE � OCCUR 717012081-0005 09/01/2015 09/01I2016 pREMISES Eaoccurrence $ �,O��,Q
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY ❑ PR� � LOC
JECT
OTHER:
AUTOMOBILE LIABILITY
A X ANY AUTO
� ALL OWNED SCHEDULED
AUTOS AUTOS
NON-OWNED
HIREDAUTOS AUTOS
X UMBRELLA LIAB X OCCUR
A EXCESS LIAB CLAIMS-MADE
DED RETENTION $
WORKERS COMPENSATION
AND EMPLOVERS' LIABILITY Y I N
B ANY PROPRIETOR/PARTNER/EXECUTIVE � N� A
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, descnbe under
DESCRIPTION OF OPERATIONS below
A Technology E80
Retro Date 9N/03
MED EXP (Any me person) $
PERSONAL 8 "�DV INJURY $
GENERALAC�3REGATE $
PRODUCTS � �OMP/OP AGG $
$
MBINED. V LE LIMIT $
Ea accident
7012081-0005 09/01/2015 09/01/2016 BODILY INJL' :Y (Per person) $
BODILY INJI ZY (Per accident) $
PROPERTY AMAGE $
Per acciden
$
EACH OCCI 2RENCE $
1012081-0005 09/01/2015 09/01/201fi AGGREGAI . $
14P30A
1012081-0005
1
1
n STATI 'E ER
09/01/2015 09101/2016 E.L.EACH :CIDENT $ �i�00
E.L.DISEA --EAEMPLOYE $ �,OOO
E.L. DISEA E- POLICY LIMIT $ 'I,OOO
09/01/2015 09101/2016 Aggrega e 2,000
EachCla n 2,OOU
DESCRIPTION OF OPERATIONS I LOCATION51 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attachetl If more space Is requlred)
Technology E60 Deductible $50,000 per claim
CITFL11
City of Clearwater
112 S Osceola Ave
Clearwater, FL 33756
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N
SHOULD ANY OF THE ABOVE DESCRIBE POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, OTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVI' IONS.
AUTHORIZED REPRESENTATIVE
'YV�:�� � �•
OO 1988-2014 ACORD COR ORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
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