Loading...
CERTIFICATE OF LIABILITY INSURANCE (725)JAGRE -1 OP ID: SW '`�� �- CERTIFICATE OF LIABILITY INSURANCE DATE 06130/2016Y) 06/30/2016 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 Brown & Brown of Florida, Inc P 0 Box 548 273 North Broad Street Brooksville, FL 34605 -0548 Randy Mazourek NAME: Susan Widler PHONE 352 - 796 -8200 FAX (A/c, No, Ext): (a/c, No): 352 - 799 -1399 E -MAIL ADDRESS: SusanWilder(aaBBBrooksville.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Westfield Insurance Company 24112 INSURED JA Green Plumbing & Mechanical Inc. 602 N. Rome Avenue Tampa, FL 33606 INSURER B: CMM3434747 INSURER C : 01/2016 INSURER D : EACH OCCURRENCE INSURER E : INSURER F : CLAIMS -MADE 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 ILTR TYPE OF INSURANCE ADDL JNSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CMM3434747 �9�%% JUL ' ; `. 201E Ilj S u i�EGC7R[D�S�[A]FP�ID 01/2016 07/01/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO REN rED PREMISES (Ea occurrence) $ 500,000 GEN'L MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 AGGREGATE POLICY OTHER: X LIMIT APPLIES PRO- JECT PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGO $ 2,000,000 Emp Ben. $ 1,000,000 A AUTOMOBILE X UABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS Ff�FigC'1AQ! CMM3434r+4T SL `E SR 57k 016 07/01/2017 SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PRO PERTYDAMAGE (Per accident) $ A X UMBRELLA LIAB EXCESS LAB X OCCUR CLAIMS -MADE CMM3434747 07/01/2016 07/01/2017 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X RETENTION$ $0 $ WORKERS COMPENSATION AND EMPLOYERS' LABILITY Y / N ANY PROPRIETOR /PARTNER/EXECUTIVE 7 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A Leased /Rented Equi CMM3434747 07/01/2016 07/01/2017 Blanket 50,000 Deducti 500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace Is required) John A. Green CF CO19132 John A. Green CM CO13422 William D. Green PMG0013 CERTIFICATE HOLDER CANCELLATION CLEARWA City of Clearwater ty 100 South Myrtle Ave., #C -110 Clearwater, FL 34616 -5520 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 JAGRE -1 OP ID: SW ACORL CERTIFICATE OF LIABILITY INSURANCE ` DATE 07/06/2016 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 Brown & Brown of Florida, Inc P 0 Box 548 273 North Broad Street Brooksville, FL 34605 -0548 Randy Mazourek NAME: ACT Susan Widler PHONE 352.796.6200 FAX (A/C, No. Eat): (NC, No): 352 - 799 -1399 AD Ress: SusanWilder @BBBrooksville.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Westfield Insurance Company 24112 INSURED JA Green Plumbing & Mechanical Inc. 602 N. Rome Avenue Tampa, FL 33606 INSURER B: ilk--.1-7..,,,, . CMM3434KCL � r t j U L d I9 I 1 201 F. } OFFICIAL. RECORDS AND LEGISLATIVE DEPT DEPT INSURER C : 07/01/2017 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY ilk--.1-7..,,,, . CMM3434KCL � r t j U L d I9 I 1 201 F. } OFFICIAL. RECORDS AND LEGISLATIVE DEPT DEPT 07/01/2016 tD 07/01/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 500,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE POLICY OTHER: X LIMIT APPLIES Sri PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 Emp Ben. $ 1,000,000 A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS �7I 7 ♦ CMM3434747 07/01/2016 07/01/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ X UMBRELLA LJAB EXCESS UAB X OCCUR CLAIMS -MADE CMM3434747 07/01/2016 07/01/2017 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X RETENT ON $ $0 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below / N N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A Leased /Rented Equi CMM3434747 07/01/2016 07/01/2017 Blanket 50,000 Deducti 500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) John A. Green CF C019132 John A. Green CM C013422 William D. Green PMG0013 CERTIFICATE HOLDER CANCELLATION CLEARWA City of Clearwater tY 100 South Myrtle Ave., #C -110 Clearwater, FL 34616 -5520 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 //7(4?4liY,?- ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD