CERTIFICATE OF LIABILITY INSURANCE (6)�� DATE (MM/DD/YYYY)
_ CERTIFICATE OF LIABILITY INSURANCE „r ,,,,��15
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), AUTHORI2ED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLOER.
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
Greene-Hazel Insurance Group
10739 Deerwood Park Blvd Ste 200
Jacksonville FL 32256
INSURED
Northeast II, Inc. dba TC
Delivers; TC Specialties Co.
5911 Philips Hwy
Jacksonvilie FL 32216
NORTH 18
INSURER A
COVERAGES CERTIFICATE NUMBER: 2138508799 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. NOTVNTHSTANDING 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 DL POLICY EFF POIICY EXP LIMITS
LTR TYFE OF INSURANCE g POLICY NUMBER MMIDDNYW MM/DDlYYYY
A GENERALLIABI��TY 01CI1084227 1(15/2015 1/15I2016 EACHOCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABII,ITY PREMISES Ea occurtencel $1,000,000
CLAIMS-MADE � OCCUR MED EXP (Any one person) $10,000
PERSONAL&ADVINJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 _
POLICY PR� X LOC $
B AUTOMOBILE LIABIIITY 810915K366315 t115/2015 1/15/2016 Ea accident 1 000 000
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Per accident
$
E X UMBRELLAUne X OCCUR ZUP14P1458A15NF 1/15/2015 1/15/2016 EACHOCCURRENCE $5,000,000
EXCESS UAB ��qIMS-MADE AGGREGATE $5,000,000
DED x RETENTION $10,000 $
F WORKERS COMPENSATION WC84000321362015A 12/3112015 12/31/2016 X �^/C STATU- OTH-
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE � N � A E.L. EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000
If yes, describe under
DESCRIPTION OF OPER,4TIONS below E.L. DISEASE - POLICY LIMIT $1,000,000
� Prof Liability 03040680 8/14/2015 8/14/2016 Prof Liab Limit 3000000
� Crime 82095695 1I15I2015 1l15/2016 Crime Limit 1000000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 701, Additlonal Remarks Schedule, if more apace is requfred)
CERTIFICATE HOLDER
City of Clearwater
100 South Myrtle Avenue
Clearwater FL 33756
ACORD 25 (2010/05)
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCOROANCE WITH THE POLICY PROVISIONS.
AUTHORIZED R(�EPRESENTATIVE
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