CERTIFICATE OF LIABILITY INSURANCE (9)�� DATE (MM/DD/YYYY)
, CERTIFICATE OF LIABILITY INSURANCE 12/29/2016
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
Greene Hazel Insurance Group � HUB International
10739 Deerwood Park Blvd Ste 200
Jacksonville FL 32256
INSURED NORTH18
Northeast II, Inc.
dba TC Delivers; TC Specialties Co.
5911 Philips Hwy
Jacksonville FL 32216
INSURER A
INSURER D
AFFORDING
I � INSURERF: � �
COVERAGES CERTIFICATE NUMBER: 777912064 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. NOTVNTHSTANDING 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR TYFE OF INSURANCE IN R WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY
C GENERAL LIABILITY CPP0021858 1/15I2016 1/15/2017 EACH OCCURRENCE $1,000,000
X DAMA E T RENTED
COMMERCIAL GENERAL LIABILITY PREMISES Ea occurtence $1,000,000
CLAIMS-MADE � OCCUR MED EXP (Any one person) $10,000
PERSONAL 8 ADV INJURY $1,000,000
GENERALAGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
X POLICY PR� LOC $
C AUTOMOBILE LIABILITY CA0031819 1/15/2016 1/15/2017 Ea accident $1,000,000
%� ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
HIREO AUTOS AUTOS
Per accident
$
C X UMBRELLALIAB X OCCUR UM60022753 1/15/2016 1/15/2017 EACHOCCURRENCE $5,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
DED x RETENTION$10,000 $
g WORKERSCOMPENSATION WC84000321362016A 12/31/2016 12/31/2017 X T RYTAiT- OTH-
AND EMPLOYERS' LIABILITY
ANY PROPRIETORlPARTNER/EXECUTIVE Y� N�A E.L. EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000
� Professional Liability EMZ128251 8/14/2016 8/14/2017 Each Claim/Aggr 3,000,000
A Crime 82095695 1/15/2016 t/15/2017 Crime Limit 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarka Schedule, if more space is required)
TE HOLDER
City of Clearwater
100 South Myrtle Avenue
Clearwater FL 33756
caNCe�uA
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� PRESENTATIVE
V �.
O 1988-2010 ACORD CORPORATION. All rights reserved.
nr.nRn 2s r2n� nins� The ACORD name and loao are reaistered marks of ACORD