CERTIFICATE OF LIABILITY INSURANCE (8)/ , � DATE (MM/DD/YYYY)
A� � CERTIFICATE OF LIABILITY INSURANCE
8/26/2016
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.
A T
PRODUCER NAME:
Greene Hazel Insurance Group � HUB International A� "E xc:904-44 - 146 n�c No: 04- 96-74 2
10739 Deerwood Park Blvd Ste 200 E-MAIL
Jacksonville FL 32256 ADDRESS:fl1fC� r neh zel.com
INSURERISI AFFORDING COVERAGE NAIC #
INSURED NORTH 18
Northeast II, Inc.
dba TC Delivers; TC Specialties Co.
5911 Philips Hwy
Jacksonville FL 32216
INSURER A
INSURER 6
INSURER E :
COVERAGES CERTIFICATE NUMBER: 1526559103 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.
NSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP
LTR INSR WVD POLICY NUMBER MM/DD/YYYY MMIDDNYW LIMITS
. GENERAL LIABILITY CPP0021858 1/15/2016 1/15/2017 EACH OCCURRENCE $1.000.000
� COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE � OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY PR� LOC
C AUTOMOBILE LIABILITY
X ANY AUTO
ALIOWNED SCHEDULED
AUTOS AUTOS
NON-OWNED
HIREDAUTOS AUTOS
C X UMBRELLA LIAB X OCCUR
EXCESS LIAB CLAIMS-MADE
DED X RETENTION $10,000
CA0031819
UMB0022753
WORKERS COMPENSATION WC84000321362015A
AND EMPLOYERS' LIABILITY Y/ N
ANY PROPRIETORlPARTNER/EXECUTIVE ❑ N � A
OFFICER/MEMBER EXCLUDED9
(Mandatory in NH)
If yes, describe under
1 /15I2016 I 1 / 15/2017
DAMA E ENTED
PREMISES (Ea occurrence $�
MED EXP (Any one person) $1
PERSONAL 8 ADV INJURY $1
GENERALAGGREGATE $�
PRODUCTS - COry1P/OP AGG $�
$
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
Per accident
$
1/15/2016 1/15/2017 EACH OCCURRENCE $5,000,000
AGGREGATE $5,000,000
12/31 /2015 I 12/31/2016
� Professional Liability EMZ128251 Sl14/2016 8/14/2017
A Crime 82095695 1/15/2016 1/15/2017
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additfonal Remarks Schedule, if more space is requfred�
CERTIFICATE HOLDER
City of Cleanvater
100 South Myrtle Avenue
Clearwater FL 33756
CANCELLATION
E.L.EACHACCIDENT $1,000,0(
E.L. DISEASE - EA EMPLOYEE $1,000,0(
E.L.DISEASE-POLICYLIMIT $1,000,0(
Each Claim/Aggr 3,000,000
Crime Limit 1,000,000
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
� !' T ���
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