CERTIFICATE OF LIABILITY INSURANCE (12) Client : 22073 RUTHECKE
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A C74C . CERTIFICATE OF LIABILITY INSURANCE 015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE ROES 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:
Bouchard Insurance(CLW) PHONE 727 447-6461 FAX 727 449-1267
(AIC,Na Ext). CAFC °I`
101 N 5tarcrest Dr. ADDRESS: cicertso@bouchardinsurance.com
Clearwater, FL 33765 INSURER(S)AFFORDING COVERAGE NAIL#
72.7 447-6481 INSURER A,Zurich American Insurance Co 16535
INSURED INSURER B.American Guarantee&Liability 26247
Ruth Eckerd Hall',Inc. INSURER C.RetailFirst Insurance Company 10700
1111 McMullen Booth Rd
INSURER D
Clearwater,FL 33759
INSURER E
INSURER F
COVERAGES 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 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.
INSR:.... ADDLSUBR .POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSR VWD POLICY NUMBER IMWDWYYYY) (MMtDDWYYY) LIMITS
• GENERAL LIABILITY CP0017156801 513112015 051311201C EACH OCCURRENCE $1,000,000
rx COMMERCIAL GENERAL LIABILITY 4 s",CE TO RENTED
PR NIISES(Ea ucczjrTe raj $100,000
II Y ono I�crson) $10,000
CLAIMS-MADE X t3CR,UR MELD EXFP fAuT T'.
Ell PERSONAL&ADVINJURY 51,0170,000GENERAI AGGREGATE 52,000,000
DEN L AGGREGATE LIMIT APPLIES PER. PRODUCTS,COMPiOP AGO s2,000,000
POLICY I PRO-
JECT .L..LOG
s
• AUTOMOBILE LIABILITY CP0017156801 0513112015 051311201 tCOMBINED c t)IN yLE LIMN $1,000,000
X ANY AUTO BODILY INJURY fPer Iruiraumj $
BODILY INJUFdY.
ALL t74'BNO=U AUTOSULFU fPer arx done) $
AUTC?a AUTOS
Tc.rNNED fAhACC
$
AUTHIRED AUTOS + IPer accident)
3
B X UMBRELLA LIA13 X OCCUR AUC967294107 513112015 051311201C EACH OCCURRENCE $10,000,000
E'XCE.SSLIAS. CLAIMS-MADE AGGREGATE $10,000,000
LTELT .I XI RETENTION$0 5
.tiN43RWGERS COMPENSATION L�lC�'T ATU- OTT I
'" AND EMPLOYERS'LIAS ILITY 05204622 110112016 011011201 X rf)RM LIMIT"3 ER
Y R
ANY PR.OPRIETGRIPARTNCRtE.XECUTIVE E.L.EACH ACCIDENT $1,000,000
OFFICFRMIEMBER EXCLUDED? Y... N dA
gMandatory In NH) E..L......DISEASE-EA EMPLOYEL $1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS 1'x0ow E.L.DISEASE-POLICY LIMIT $1,000,000
A ,Abuse/M olestat an GLCO17156901 513112015 051311201 $1,000,0001$1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101.Additional Remarks Schedu Ie,ik more space is required)
This certificate is a reflection of the current coverages provided for the insured.Limits and coverages
are afforded to the certificate holder only if required by written contract.
EVIDENCE OF INSURANCE
CERTIFICATE HOLDER CANCELLATION
CITY OF CLE,ARNJATER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
112 S OSCEOLA AVENUE ACCORDANCE WITH THE POLICY PROVISIONS.
CLEARWATER,FL 33756
AUTHORIZED REPRESENTATIVE.
C7 1 988-201 0 ACORD CORPORATION.All rights reserved„
ACORD 25(2010105) 1 of 1 The ACORD name and to-go are registered marks of ACORD
#S350343/M35031'5 KIMCA