CERTIFICATE OF LIABILITY INSURANCE (897) OP 10:PB
CERTIFICATE OF LIABILITY INSURANCE
THIS CERTIFICATF IS ISSUED A$A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLLER,THIS
CERnFIC.ATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORIDED BY THE POLICIES
BELOW, THIS CERTIFICATE or INSURANCE DOES NOT CONSTITUTE A CONTRACT RETWEEN THE ISSUING INSURER(U AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate Fulda'is an ADDITIONAL INSURED,the pallcy(ies)mwt ba andmsW. if SUBROGATION IS WAIVEM suNoc 6
the terms and conditions of the poiioy,cartalrk po.Ilcles bray require an orldorsen artt. A statement cm us cett OM dOOS not confer fights to the
cert flats holder in lied of such al�dnrsman s.
PRODUM fIldrid Addisen&MCKoi1s =114T Fairchild,Addison and MCKOne
P_fl_Rax 1030 AHeN£ 873.6814893 FAx ,813- 5-86'IG
Eirandon F43Qawes" s CCNSFAMins oorn w
FakiMild AMson&M cKone
cusT0MER1D r:ALLU,1
�.._..... _ IKSGR +1eRaiRG C4VfataGE ___. .__ twat
1M upm Alt-Eros E eEO nt wsuRErta:tlnEzeB Etre�r Ctlsu9lt 13021
Joseph T oew �. �7� .._.
POB 11211 afaur a s. --
Spring Hifi,FL 34870 >wfsuiac:
CILSURER ra:
W5uRIFR F:
COVERAGES CERTIFICATE NUMBER; REVISION NUMBER.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUE=D TO YHE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TELA OR cowo rioN OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN ES SUBJECT TO ALL THE TENS.
EXCLUSION$AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED SY MAID CLAMS.
ow
F... pblElr
LT9 TYK OF 11115MANCE POUCY NUMERLNNtfS
G£NE7iW LIABIlfFY EACH QMVPRENCI: 3 7000
A X COW ERCIALGFNERALLIABILITY 60380776 o2f25A2078 02f25 me IS - 3 1aD
G.AWS-MWE 1-K OCCUR MED ERP a _ •$'
PER50NAL&ADV INJURY S 1�
GENERALAGGREGATE i 2,Ogp
MP;LAGGREGATE IAA APPLMS PER: PRODUCTS-COump AGO t �
�IICY PRO LOC S
A11TO DUI E l.TRBRM QDWINED SINGLE LIMIT S 1aa,
A X AwAuTG 38117rs 4712S12p78 1192W2079 t �
ALL OWNED AUTAS $44tI,Y INJURY{pCrpmwn} �
SGHEOULEO AUTOS BODILY MURY(Per atckvm i
PROPERTY DAMWE T
HMO AUTOS {PkR ACCIK"
5
UMUM LA IJA1J 0(=ft EACIi OCCI IRI;EHGE f
OWES$LIAG CLUIS-MADE. AGGREGATE i
RE MOH t li S
W0RKFk:Sa0WM9ATPM ! VvcSwtT
AMe 04"YERS'LEAWLITY
RKY rRUPk:fY4A1AtR7}lERri xEc UrnlE YH A E.L EAC"ACV11ENT s
QFFIEERJhAEIAeER E7CEF il�f3?
t telldabor k4.me. I CL 015EA5E-EA DAPLOYE s
5ER5E-PCLSCY 1 IIr'T. g .
j !
DEs,CRIPr"OF OPE"TOM I L=HOWI VEHICLES[AMch ACORD 101,Adpilfohal AwTm r,Sctw4&if mom*Poce I€mquitao
Email:brace:Rriffin0myclearwater-corn
CERTIFICATE Hp DER CANCELLATION
CLFAG-2
SHOULD ANY OF THE ABOVE DESCRIBED POLIC4E5 BE CANCELLED BEFORE
THE EXPIRAMN DATE THEREOF, f OTTCE WILL BE DEIJHFRED Ni
Clewwater Gas System ACCORDANCE Wn'H THE POLICY PROVI3 MS.
Apo f9orth Myrtle Awe
Clearwuter,FL 33755 AUTHARILEM RLtPFkU% TTATWVE
FallreWld+Addison&McKone
c 1988• ACORD COR A"ON, All CIgW
ACORD 25(2Rif91098) The ACORD harm and logo are registered Mlkfti5 Cf ACORD