CERTIFICATE OF LIABILITY INSURANCE (825)ACORD I DATE (MMIDD/YYYY)
�� CERTIFICATE OF LIABILITY INSURANCE 1�19�zoi�
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, ceRain 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 ONTACT Ldl1Y'10 Sack � CPCU, CIC
NAME:
Stahl 6 Associates Insurance, Inc. PH�NE .(727) 391-9791 aC No: �72��393-5623
110 Carillon Parkway e �R�F��.laurie.sack@stahlinsurance.com
St. Petersburg FL 33716
INSURED
Interprint Inc 6 Morten Enterprises Inc
12350 US HIGAWAY 19 N
CLEARWATER FL 33764
INSURER S AFFORDING COVERAGE NAIC #
INSURERAAm@=1CdII Econom Ins Co 19690
INSURERB:General Ins Co of America 24732
iNSUrtertcAmerican States Ins Co 19704
INSURER D:FFVA M11t1131 Insurance Co
INSURER E :
COVERAGES CERTIFICATE NUMBER:CL16121234800 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. N0TIMTHSTANDING 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.
�N7R TYPE OF INSURANCE ADDL SUBR pOLICY NUMBER MMIDDY� MMIDDY� LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1, 000 , 000
A CLAIMS-MADE � OCCUR DAMAGE TO RENTED 1, 000 , 000
PREMISES Ea occurrence $
X 26CC19233900 7/1/2016 7/1/2017 MED EXP (Any one person) $ 10 , 000
PERSONAL 8 ADV INJURY $ 1, 000 , 000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2, 000 , 000
X POLICY � PR� � LOC PRODUCTS - COMP/OP AGG $ 2, 000 , 000
JECT
OTHER: $
AUTOMOBILE LIABIIITY COMBINED SINGLE LIMIT g 1, 000 , 000
Ea accident
B %� ANY AUTO BODILY INJURY (Per person) $
ALLOWNED SCHEDULED 24CC31924510 7/1/2016 7/1/2017 BODILYINJURY(Peraccident) $
AUTOS AUTOS X
NON-ONMED PROPERTY DAMAGE $
HIREDAUTOS AUTOS Peraccident
Uninsuredmotaristcombined $ 500,000
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1 000 000
C EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1 000 000
DED X RETENTION$ 10 000 O1SU3942269 7/1/2016 7/1/2017 $
WORKERS COMPENSATION x PER OTH-
AND EMPLOYERS' LIABILITY y� N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1, O00 , 000
OFFICER/MEMBER EXCLUDED? � N � A
D (Mandatory in NH) WC84000163292017A 1/1/2017 1/1/2018 E.L. DISEASE - EA EMPLOYE $ 1 000 000
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 000 000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Addklonal Remarks Schedule, may be attached iT more space ia requlred)
The City of Clearwater and Clearwater Gas are included as additional insured with respects to General
Liability, and auto as required by written contract.
Carol.Barden@myClearwater.
City of Clearwater
PO Box 4746
Clearwater, FL 33758
ACORD 25 (2014/01)
I NS025 r�m am �
TION
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
Kelly Petzold/SACK ���� � P�`�`'--
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