CERTIFICATE OF LIABILITY INSURANCE (11)� � CERTIFICATE OF LIABILITY INSURANCE Qj17�'nM�D/YYYY)
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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
1U6 International Florida
10739 Deerwood Park Blvd Ste 200
lacksonville FL 32256
INSURED NORTH 18
Northeast II, Inc.
dba TC Delivers; TC Specialties Co.
5911 Philips Hwy
Jacksonville FL 32216
COVERAGES
CERTIFICATE NUMBER: � 069101568
PHONE
INSURER B
INSURER D :
INSURER E :
REVISION NUMBER:
NAIC #
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTIMTHSTANDING 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 TypE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LIMITS
LTR IN R WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
B GENERAL LIABILI7Y CPP0021858 1/15/2017 1/15/2018 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENER.4L LIABILITY AMA RENTED
PREMISES Eaoccurrence $1,000,000
CLAIMS-MADE � OCCUR MED EXP (Any one person) $10,000
PERSONAL&ADVINJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
X POLICY PR� LOC $
B AUTOMOBILE LIABILITY CA100009846 1/15I2017 1/15/2018
Ea accident $1,000,000
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Per accident
$
B X UMBRELIALIAB 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 $
q WORKERSCOMPENSATION WC84000321362016A � 12/31/2016 12/31/2017 X �YTATU- OTH-
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y� N j E.L EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? � N / A
(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 EMZ128252 8/14/2017 8/14/2018 Each Ciaim/Aggr 3,000,000
� Crime 106664402 1/15/2017 1/15/2018 Crime Limit 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, AddRional Remarks Schetlule, if more space fs requlred)
City of Clearwater
100 South Myrtle Avenue
Clearwater FL 33756
ACORD 25 (2010/05)
CANCELLA
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
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�O 1988-2010 ACORD CORPORATION. All rights reserved.
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