CERTIFICATE OF LIABILITY INSURANCE (35)
ACORDm
CERTIFICATE OF LIABILITY INSURANCE
OP 10 T DATE (MM/DDIYYYY)
BRIE001 05 03/07
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
J.W. Edens & Company
Commercial Ins of Brevard, Inc
325 Fifth Avenue, Suite 108
Indialantic FL 32903
Phone: 321-725-7000 Fax:321-725-7856
INSURED
Brickner Electric, Inc.
Dale Brickner
1880 Canova St
Palm Bay FL 32909
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
Old Dominion Insurance Company
NAIC#
40231
INSURERS AFFORDING COVERAGE
Brid efield Emplo ers Ins.
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSRC POLICY NUMBER P-QI:!~1,E~rJ~~E PO~lpEY(~~bRA";!gN LIMITS
LTR TYPE OF INSURANCE DATE MM/DD DATE MM/DDIYY
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
- UAMAul: I V":,, I IOU
A X COMMERCIAL GENERAL LIABILITY MPG76455 02/01/07 02/01/08 PREMISES (Ea occurence) $ 500000
-- -- --~l;l](IMSMADE-&V"''''U'' ----. --.---- --~~--- ------ ~----:. --- MIOU ,,^I"' (Any or\~) 'I> .LuuuO-- -
PERSONAL & ADV INJURY $ 1000000
GENERAL AGGREGATE $ 2000000
GEN'L AGGREnE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2000000
I PRO- n
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $ 500000
A ~ ANY AUTO BIG76455 02/01/07 02/01/08 (Ea accident)
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
HIRED AUTOS BODILY INJURY
- $
NON-OWNED AUTOS (Per accident)
--
I ------ PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
=l ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AGGREGATE $
$
=l DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X I TORY LIMITS I IU~~-
EMPLOYERS' LIABILITY 830-35970 04/01/07 04/01/08 $ 100000
~--- --A!1y,ggQpR!EInR/PAPTI\II=P/r:.Vt:f'IITI\l1= E.L. EACH ACCIDENT
--
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 100000
If yes, describe under E. L. DISEASE - POLICY LIMIT $ 500000
SPECIAL PROVISIONS below
OTHER
I "'... r .--
II
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS -... -..",..
MftY 1 J 2007
OFFICIAL RECORDS AND
LEGISLATIVE SRVCS DEPT
CERTIFlCATE HOLDER CANCELLATION
CITYCL2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Philli Lane
, ITS AGENTS OR
City of Clearwater
112 South Osceola Avenue
Clearwater FL 33756
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPO
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001/08)