CERTIFICATE OF LIABILITY INSURANCE (10)DATE (MM/DD/YYYY)
�oRO� CERTIFICATE OF LIABILITY INSURANCE 1/16/2017
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), AUTHORI2ED
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
NAIC #
INSURER F :
COVERAGES CERTIFICATE NUMBER: 1421740543 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 A �� � POLICY EFF POLICY EXP LIMITS
LTR 'n'PE OF INSURANCE INSR WVD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY
B GENERAL LIABILIn' CPP0021858 1/15I2017 1/15/2018 EACH OCCURRENCE $1,000,000
x DAMA E N D g�,000,000
COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence
CLAIMS-MADE � OCCUR MED EXP (Any one person) $10,000
PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
%� POLICY PR� LOC $
B AUTOMOBILE LIABILI7Y CA100009846 1/15/2017 1/15/2018 Ea accident 1,000,000
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS PROPERTY DAMAGE
HIRED AUTOS A�T S�ED Per accident $
$
B X UMBRELLALIAB X OCCUR UM60022753 1/15/2017 1/15/2018 EACHOCCURRENCE $5,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
DED x RETENTION $10,000 $
/{ WORKERSCOMPENSATION WC84000321362016A 12/31/2016 12/31I2017 X WRY IMiU- OTH-
AND EMPLOYERS' LIABILITY Y/ N
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N� A E.L. EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED?
(Mandatory in NW) E.L. DISEASE - EA EMPLOYEE $1,000,000
If yes, describe under
DESCR�PTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000
� Professional Liabiiity EMZ128251 9/14I2016 8114/2017 Each Claim/Aggr 3,000,000
� Crime 106664402 1l15I2017 1115/2018 Crime Limit 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES �Attach ACORD 101, Additional Remarks Schedule, if more space is required)
TE HOLDER
City of Clearwater
100 South Myrtle Avenue
Clearwater FL 33756
ACORD 25 (2010/05)
CANGELLATION
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
i
� � ��
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