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CERTIFICATE OF LIABILITY INSURANCE (712)
A RDr CERTIFICATE OF LIABILITY INSURANCE -"' DATE (MM /DD/YYYY) 6/14/2016 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 Adcock - Adcock Insurance Agency 315 W. Fletcher Ave. Tampa FL 33612 -3414 NAME: NTACT Thalia King PHONE 813- 933 -6691 FAX 813- 932 -6287 (A /C. No Fst). IA /C. Nol: ADDRESS: thaliak adcock- insurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Owners Insurance Co. 32700 INSURED 70 Smith & Hudson Interiors Inc 5003 N. 40th St. #101 Tampa FL 33610 -5237 INSURER B :Auto- Owners Insurance Co. 18988 INSURER C :Southern-Owners Insurance Co. 10190 INSURER D : $500,000 INSURER E : INSURER F : X OVE • fALVI•JIVIV 1VVIVIUGrn. 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 ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DDIYYYY) POLICY EXP (M MIDD/YYYY) LIMITS A x COMMERCIAL GENERAL LIABILITY 20663654 RECENED I JUN i ZQ�6 OFFICIAL RECORDS 9541917t�S�mE .7R C5/}1�}6r !lY W 7/1/2016 ANN LV/LL1�' 7/1/2017 7/1/2017 EACH OCCURRENCE $500,000 CLAIMS -MADE X OCCUR DAMAGE SET Ea occurrence) $50,000 GEN'L X MED EXP (Any one person) $5,000 PERSONAL 8 ADV INJURY $500,000 AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: GENERAL AGGREGATE $1,000,000 PRODUCTS- COMP /OPAGG $1,000,000 (Ea accident) SINGLE LIMI $ $1,000,000 B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ PIP -Basic $10,000 C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 9541917801 7/1/2016 7/1/2017 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DED X RETENT ON $10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A PER I OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RTIFICATE HOLDER CANCELLATION City of Clearwater 100 S Myrtle Clearwater FL 34237 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 ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD