CERTIFICATE OF LIABILITY INSURANCE (718)•
ACORDTM CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YYY1f)
6/23M/DDN
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(les) 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
BB &T - Boyle Vaughan Insurance
2000 Center Point Rd, Ste 2400
P. 0. Box 8628, 29202
Columbia, SC 29210
CONTACT Sharon Blackwell
PHONE 803 748 -0100 FAX 8774677214
(NC, No, Exd): (A/C, No):
E -MAIL
ADDRESS:
INSURERS) AFFORDING COVERAGE
NAIL II
INSURER A: Zurich American Insurance Compa
16535
INSURED
Anchor Sign Inc
PO Box 22737
Charleston, SC 29413
INSURER B : Liberty Insurance Corporation
42404
INSURER C
06/26/2017
INSURER D :
$1,000,000
INSURER E :
INSURER F :
X
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 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.
LTR
TYPE OF INSURANCE
ADDLSUBR
INSR
W VD
POLICY NUMBER
POLICY EFF
MI
(MDDIYYYY)
POLICY EXP
(MMIDD/YYYY1
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
GL0595566403
�I(GCEN
{ ))
` S ? LQ�
��a pry`
'►1 RECORDS
6/26/2016
/*I
06/26/2017
EACH OCCURRENCE
$1,000,000
CLAIMS -MADE
X
OCCUR
PREMISES(beoccurrrrence)
$300,000
MED EXP (Any one person)
$10 000
PERSONAL & ADV INJURY
$1,000,000
$2,000,000
GEN'L
AGGREGATE
POLICY
OTHER:
X
LIMIT APPLIES
PRO-
JECT
PER:
LOC
GENERAL AGGREGATE
PRODUCTS - COMP/OPAGG
$2,000,000
$
A
AUTOMOBILE
X
X
X
LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
Drive Oth Car
X
SCHEDULED
AUTOS
NON -OWNED
AUTOS
n�
BAP5968 /'v SIN/2016
L
06/26/2017
COMBINED SINGLE LIMIT
(Ea accident /
$1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
B
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
TH7651290012
06/26/2016
06/26/2017
EACH OCCURRENCE
$5,000,000
AGGREGATE
$5,000,000
DED
X
RETENTION $10000
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? LNJ
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
WC595566503
06/26/2016
06/26/2017
X
STATUTE
ERH
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
E.L. DISEASE - POLICY LIMIT
$1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
David W Jackson is qualifier for Anchor Sign / ES- 00000291
CERTIFICATE HOLDER
CANCELLATION
City of Clearwater
PO Box 4748
Clearwater, FL 33759
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
01988 -2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) 1 of I The ACORD name and logo are registered marks of ACORD
#S16376988/M16375114
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