CERTIFICATE OF LIABILITY INSURANCE (676)A`CC>RE) CERTIFICATE OF LIABILITY INSURANCE
DATE(MM /DDNYYY)
112/30/2015
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
Brown & Brown Insurance - Clearwater
83 Park Place Blvd., Suite 101
Clearwater FL 33759
NAME: Linda Waldorf
PHONE 727- 461 -6044 FAX 727- 442 -7695
E -MAIL . lwaldorf@bbpinellas.com
inellas.com
INSURERS AFFORDING COVERAGE
NAIC #
INSURERA:Zurich American Insurance Co.
16535
INSURED PUREAI2
Pure Air Control Services, Inc
Building Health Check LLC
4911 Creekside Dr., Ste. C
Clearwater FL 33760
INSURER B:
COMMERCIAL GENERAL LIABILITY
INSURER C:
INSURER D:
INSURER E:
INSURER F:
MCVIOIUIV NUMOLK:
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.
INSR
LTR
TYPE OF INSURANCE
INSD
I WVD
I POLICY NUMBER
POLICY EFF
MM /DD/YYYY )
POLICY EXP
(MM/DD/YYYYJ
LIMITS
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE D OCCUR
EACH OCCURRENCE
$
DAMAGE TO RENTED
PREMISES Ea occurrence
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
GEN'L
POLICY ❑ PRO-
JECT LOC
PRODUCTS - COMP/OP AGG
$
OTHER:
$
A
AUTOMOBILE
LIABILITY
BAP008680600
1/1/2015
2/25/2016
Ea COMBINED LE
$1,000,000
X
ANY AUTO
BODILY INJURY (Per person)
$
ALL OWNED SCHEDULED
BODILY INJURY (Per accident)
$
AUTOS AUTOS
X
HIRED AUTOS X NON -OWNED
AUTOS
PROPERTY DAMAGE
$
Per accident
$
UMBRELLA LIAB
OCCUR
HCLAIMS-MADE
EACH OCCURRENCE
$
EXCESS LIAB
AGGREGATE
$
DED RETENTION $
A
WORKERS COMPENSATION
WC008680701
1/1/2016
1/1/2017
X
$
AND EMPLOYERS' LIABILITY Y / N
STATUTE ERH
E.L. EACH ACCIDENT
$1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? N
N / A
(Mandatory In
If yes, describe under
E.L. DISEASE - EA EMPLOYE
$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)
For information purposes only.
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City of Clearwater
100 South Myrtle Avenue
Clearwater FL 33756
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
4
U 1955 -2u'14 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
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