CERTIFICATE OF LIABILITY INSURANCE (10) "cma DATE iMMIDDIYYYY)
CERTIFICATE + LIABILITY I 1111/2018
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(les) must have ADDITIONAL INSURED provisions or 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 NAME: _ 011via Kelley
Brown &Brawn Insurance-ClearwaterNT
PHONE
83 Park Place Blvd#101 AAmjo J X727 45Q-7321 iArc M6k— - —
Clearwater FL E-MAIL 337a9 ADDRJEss:.gkglll�y�bbpirlellas.cam
INSURER(S)AFFORDING COVERAGE NAIL#
INSURERA Zenith Insurance Company 13288
INSURED IMAGE-$ INSURER B;Twin Ci Flre Insce Co. � 29459
Image One Corporation _ _.. uran—
Lencor LLC dba image One INSURERC:Illinois Union Insurance Company 27980
6212 Benjamin Road, Suite f#103 INSURER D i Allied Insurance Company of America 10127—
Tampa FL 33634 INSURERE:
INSURER F
COVERAGES CERTIFICATE NUMB ER.*29251171 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 VMTH 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
e.. .._ _
INSR�TYPE OF INSURANCE ADDL UBR - POLICYEF:F POLICY EXa ...... ...._.. ......
POLICY NUMBER '..... MMMR=) (MWDDrYYYYI LIMITS
11 )(. COMMERCIAL GENERAL LIABILITY Y AGP3D17594445 3//512017 3115/2018 EACH CCCURRENCE $1,000000
I "i3` ZCCE"TO ._..m�.
CLAItr&MADE X OCCUR F 9EMISES{Ea ocCurc@noel $31]01000
MED EXP(Any orae person) $5.450
PERSONAL&ADV INJURY $1.000,00,0
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
POLICY PRO- LOCJECT �. PRODUCTS-COMMOPAGG $2,OOG,000
OTHER: S
D AUTOMOBILE LIABILITY Y ACP3017594445 3115/2017 '3115!2'.018 COMBINED SINGLE LIMIT S
Ea aceldent] 1 C.
X '....ANY AUTO BODILY INJURY(Per person) 5
OVNNED SCHEDULED
AUTOS ONLY L- AUTOS BODILY INJURY(Per ecclaent) s
HIRED NON-OWNED PROPEi, AMAGE -S.. '
AUTOS ONLY AUTOS ONLY '. I -(Per
aCCaFfanl.
PIP $10.000
D UMBRELLA LIAB X OCCUR ACP3017594445 3/1512017 3111/2018 EACH OCCURRENCE $3.000,000
EXCESS LIAR CL;i.IMS-MADE AGGREGATE $3.004,000
DED X REI,'E ir:_ONS rar) $
A WORKERS COMPENSATION 207242$008 111/2018 1/1/2019 }(_ PER QTH
AND EMPLOYE RS°LIAB..ILITY Y 7 N STATUTE ER
ANYPROPRIETO€iPARTNERIEXECUTiVE F"";'°`"
OFF ICERIME.MBEREXc"L.UDED? N i A- E.L.EACH ACCIDENT_ j $1.000, 00 ..
(Mandatory in NH) E.L DISEASE-EA EMPLOYEE S J.GO
If es des nwe.tn0ar
...........,m.Y...,-�,..— ...�,-
D SCRIPT ION OF OPERAT?ONS below E.L.DISEASE-POLICY LIMIT $1,000.000
C Prof.Tachology 3.Internet. G22 535330 007 3/1512017 311512018 General Aggregate 2,000,000
B EPLII Fiducra;+113ra Paaty +.KRn2:a<037 3115/2017 3115!2098 -.General Aggregate 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IAOORD 101,Additional Remarks Schedu.W,may be attached If more space Is required)
Certificate holder is an Additional Insuredas required by written contract. Cle3rWater
I I "ix.bra r
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of ClearwaterACCORDANCE WITH THE POLICY PROVISIONS,
PO Box 4748
Clearwater FL 33758-4748 AUTHORIZED REPRESENTATIVE
X71988-2015 ACORD CORPORATION, All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
Sales Proposal
Date: 1/2/2018 ProposalType
Kristina Pasley 4"k-- Image One Hardware
Clearwater Public Library
100 N Osceola Ave Sales Person Jack Cord
6202 Benjamin!•toad,Suite 103,Tampa, FL 3361
Clearwater 4307 Vineland Road,Suite H-6,Orlando,FL 3281
FL Telephone:800-956-9000
33756 Facsimile-813-887-5359
Phone: 7276624970 Quote ID#: Fax:
Price Price
Qty Description Each Extended
Scan Pro 3000 with 26 MP Camera US13 3 Connect $ 9,990.00 $9,990,00
Auto Scan Roll Film-Fiche and Card Carrier
UCC 610 Motorized Roll carrier for 16, 35 and
cartridge rolls
Software Included with 1 year on site warranty
Optional on Site installation and training $ 595-00 $595,00
Est.Shipping;
Terms: Net 30 TOTAL:
Customer Acceptance
By signing below,the customer warrants that he/she is authorized to place order on behalf of the company,accepts the terms of this
agreement,and authorizes Image One to order the equipment or software quoted herein,install the equipment or software at the customer's
location,and remit timely payment to image One Corporation. Customer agrees that invoiced amounts not paid to terms will be subject to
late fees of 1 and 1/2 percent per month.All sales are Final.Defective products with be either fixed or replaced.
Customer Acceptance Date Image One Corporation
Clearwater Public Library
Prices are firm for 30 days from the date of this proposal and are subject to change without notice thereafter.