CERTIFICATE OF LIABILITY INSURANCE (9)
ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDD/YYYY)
1M 07/20/2007
PRODUCER (407)886-3301 FAX (407)886-9530 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
GENTRY INSURANCE'AGENCY, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
175 East Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO Box 2046
APOPKA, Fl 32704-2046 INSURERS AFFORDING COVERAGE NAIC#
, .
INSURED Clark Sales Display Inc INSURER A: Valley Forge Insurance Co./CNA
POBox 1007 INSURER B: Auto-OWners Ins Co 18988
Tavares, Fl 32778 INSURER c: .
-
INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABO\fE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE POLICY NUMBER POL LIMITS
LTR NSR DATE-'MMJJ5OiYYJ- DATE IMMlDDIYYI
GENERAL LIABILITY 2072710292 08/01/2007 08/01/2008 EACH OCCURRENCE $ 1,000,000
-
X COMMERCIAL GENERAL LIABILITY ~~~~:s~s YE~~~~~nce\ $ 300,000
I CLAIMS MADE [I] OCCUR MED EXP (Anyone person) $ 10,000
A X PERSONAL & ADV INJURY $ 1,000,000
I--
GENERAL AGGREGATE $ 2,000,000
I--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COM~OPAGG $ 2,000,000
n -nPRO. n
POLICY JECT LOC
AUTOMOBILE LIABILITY 4689364600 08/01/2007 08/01/2008 COMBINED SINGLE LIMIT
X ANY AUTO (Ea accident) $
RECEI\ 'ED 1,000,000
-
ALL OWNED AUTOS BODILY INJURY
,--- (Per person) $
SCHEDULED AUTOS
B X HIRED AUTOS AUG 1 G 2 07
BODILY INJURY
X (Per accident) $
NON-OWNED AUTOS
- Of F/ClAl RECOR )S AND
PROPERTY DAMAGE $
---'- lE ;/SIATIVE ~Dvr 'C: III=PT (Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
==i ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY 4253955702 08/31/2007 08/31/2008 EACH OCCURRENCE $ 2,000,000
:IJ OCCUR o CLAIMS MADE AGGREGATE $ 2,000.000
B ollows Form $
=1 DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I TORY LIMITS T IU~~-
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
ANY PROPRIETORlPARTNERlEXECIJTIVE
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
If ~es, describe under E.L. DISEASE. POLICY LIMIT $
S ECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
~E: Holiday Decorating Services
~ity of Clearwater is included as Additional Insured on General liability and Auto liability.
10 days notice allowed for non-payment, 30 days notice allowed for all other reasons.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
City of Clearwater ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Attn: Kyle Kilian BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
PO Box 4748 OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES.
Clearwater, Fl 33758-4748 AUTHORIZED REPRESENTATIVE Q).tn, d.LJkrv.--J:k,
Debra liebknecht/DAWN
ACORD 25 (2001/08) FAX: (727)562-4825
@ACORDCORPORATION 1988