CERTIFICATE OF LIABILITY INSURANCE (796)�® CERTIFICATE OF LIABILITY INSURANCE
DATE(MM /DD/YYYY)
11/5/2015
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
Brier Grieves Insurance
3617 Henderson Blvd.
Tampa FL 33609
CONTACT Diane Lippincott
NAME: pp
PHONE (813) 876 -4166 A/C No; (813)870 -0170
E-MAIL dianel @bgains. com
INSURERS) AFFORDING COVERAGE
NAIC #
INSURERA:Ohio Security Insurance
24082
INSURED
Encore Broadcast Equipment Sales Inc.
2104 W Kennedy Blvd
Tampa FL 33606
INSURER B Ohio Casualty Insurance
24074
INSURERCRetail First
INSURER D :
INSURER E :
EACH OCCURRENCE
INSURER F:
COVERAGES CERTIFICATE NUMBER:CL1511511824 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 CONTRACTOR 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.
INTRR
TYPE OF INSURANCE
IN.Q
SUBR
POLICY NUMBER
MM /DDY
MM /DDY�
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE Fx_] OCCUR
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 300,000
MED EXP (Any one person)
$ 15,000
EKS56457143
11/10/2015
11/10/2016
PERSONAL & ADV INJURY
$ 1,000,000
AGGREGATE LIMIT APPLIES PER
POLICY ❑ PRO-
JECT El LOC
GENERAL AGGREGATE
$ 2,000,000
GEN'L
X
PRODUCTS - COMP /OPAGG
$ 2,000,000
Experience Mod Factor 1
$
OTHER:
AUTOMOBILE
LIABILITY
(Ea O COMBINED SINGLE LIMIT
$ 1,000,000
BODILY INJURY (Per person)
$
A
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BKS56457143
11/10/2015
11/10/2016
BODILY INJURY (Per accident)
$
X
NON-OWNED
HIRED AUTOS X AUTOS
PROPcciERTY DAMAGE
Peradent
$
X
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$ 1 000 000
AGGREGATE
$ 1,000,000
B
EXCESS LIAB
CLAIMS -MADE
DED RETENTION$
$
ES056457143
11/10/2015
11/10/2016
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
(Mndat/ry InNH)EXCLUDED?
If yes, describe under
NIA
520 -22521
9/1/2015
9/1/2016
X PER OTH-
I STATUTE 1 1 ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
The City of Clearwater is listed as additional insured.
City of Clearwater
100 S. Myrtle Avenue
Clearwater, FL 33758
OR WIN ILUl CI
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Brier Grieves /NANCY � _,.e _,�Z/141-7:6-
V 1958 -2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
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