NEW AIRPLANE T-HANGARS AT CLEARWATER AIRPARK - 14-0031-AP - CERTIFICATE OF LIABILITY INSURANCEACbRJY CERTIFICATE OF LIABILITY INSURANCE
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DATE(MMIDDrMY)
1 03/04/2015
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 Iieu of such endorsement(s).
PRODUCER
�I'ITACT
M : Jayme Martina
PHONE 850- 653 -2161 FAX, w: 850. 653 -8946
Marks Insurance Agency, Inc.
a m arksinsurance.com
P.O. Sox 129
INSURER(S) AFFORDING COVERAGE
NAICI
Apalachicola, FL 32329 -0129
INSURER A: Southem Owner
01/01/2016
EACH OCCURRENCE
INSURED
INSURER B. Auto Owners
PREMISSE.S Eadcaarerrce
rNsvRERc: r' e I m to ees
Cathay Const 8t Development
INSURER D:
PO Box 13147
INSURERS:
Mexico Beach, FL 32410 -3107
INSURER F:
COVERAGES CERTIFICATE NUMBER: 00000800.558458 REVISION NUMBER: R
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 MAYBE 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.
LLTTRR
TYPE OF INSURANCE
N `
JPM
POLICY NUMBER
POLICY EFF
POLICY YY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE FRI OCCUR
Y
Y
084822- 78124197 -15
01/01/2015
01/01/2016
EACH OCCURRENCE
s 1 M01 000
PREMISSE.S Eadcaarerrce
$ 300,000
MED EXP [Any one person]_
$ 10,000
PERSONAL & ADV INJURY
$ 11000,000
GEN'L AGGREGATE LIMIT APPLIES PER-
GENERAL AGGREGATE
s 2,000,000
�( POLICY jEC7 LOC
PRODUCTS - COMPIOPAGG
$ 1,000,000
$
OTHER:
B
AUTOMOBILE
LIABILITY
4732839101
01/01/2015
01/01/2016
CEaZ=NGLE IJMrr
$ to(10.00L
BODILY INJURY (Per person)
$
ANYALI'TO
IX
ALL OWNED SCHEDULED
AUTOS AUTOS
S
BODILY INJURY [Per accidenq
NON -OWNED
HIREDAUT65 AUTOS
PROPERTY DAMAGE
ontl
$
A
X
UMBRELLA "AD
OCCUR
47 -255 -030 -02
01/0112015
01101/2016
EACHOCCURRENCE
s 1 .DOD 000
AGGREGATE
s 11(m),000
EXCESS LIAe
](
CLAIMS -MADE
DED I I RETENTION S
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY ANY PROPRIETOMPARTNERIEXECLTIVE YIN 71
OFFICERIMEMBER EXCLUDED?
(Mandstory inNH)
NIA
0830.47903
01/01/2015
01/0112016
X PER Ol FF UTE
EL EACH ACCIDENT
$ 11000,000
E.LDISEASE- EAEMPLOYE
S 1,000,000
If yyees, describe under
DESCRIPTICH OF OPERATIONS below
EL DISEASE- POLICY LIMrr
-
S 1,000 ,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additlenal Remarks Schedule, Bray be attached I mono space Is required)
Project Name: T- Hangars at Clearwater Airpar
The City of Clearwater has been listed as addi (Insured.
CERTIFICATE HOLDER CANCFI L ATinm
®1988.2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
Printed by JPM on March 04; 2015 at 02:30PM
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
The City of Clearwater
100 S. Myrtle Avenue
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Clearwater, FL 33756
AUTHORIZED RI: TAriNE
JPM
®1988.2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
Printed by JPM on March 04; 2015 at 02:30PM