CERTIFICATE OF LIABILITY INSURANCE (3)
ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIODIYYYY)
TM 06/29/2007
PRODUCER Phon,,: (727) 446.5721 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ALL LINES INSURANCE GROUP INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1345 S MISSOURI AVE HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
CLEARWATER Fl33756 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
. INSURERS AFFORDING COVERAGE . NAIC #
. . _m____....___._._____._.._.m..._...___..___._ ---- ~~-..-_.._.
INSURED INSURER A: SCOTTSDALE INSURANCE
688 SKATE PRO SHOP II --_. .----- I -...----.- -.-..
INSURER B: .:~~~F~
6140 UlMERTON RD INSURER C:
CLEARWATER Fl 33760 ....--.-- -
INSURER 0:
--. ---- -
INSURER E:
COVERAGES
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 WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT :'[0 All THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
---1 ~"-T--..m..----.-.----------.------
'~i: I~~~~ TYPE OF INSURANCE
I f_GENERAllIABllITY
t'-.Xl COMMERCIAL GENERAL LIABILITY
--=f~J CLAIMS MADE [!J OCCUR
__J __
fm-J ---.----
[GE_N'l AGGREG!:,TE L~~6 APPLIES PER:
r l POLICY f'-l JEer n LOC I
!I ~~TOMOBllE LIABILITY I
, l ANY AUTO
i"'1 ALL OWNED AUTOS I
[] SCHEDULED AUTOS
LI HIRED AUTOS
1 NON.OWNED AUTOS
':--i
---I ~---
CLS1246658
POLICY EFFECTIVE
DATE
06128/07
Pg~~:,~:~~~N
06/28/08
LIMITS
POLICY NUMBER
A
EACH OCCURRENCE $ ____.__1!000,OO.l!.
~~~~~~~~:~~nce) $______100,000
MED EXP (Anyone person) __ ~___ ______u__~~.E~
PERSONAl & ADV INJURY !..__ ____...1..l!.<!.O'-OOO
GENERAL AGGREGATE._ $___ _____?-'.Q~O,OO~
PRODUCTS-COMP/OP AGG. $ _.______~~~~!O~O_
RECEIVED
AUG 2
2007
COMBINED SINGLE LIMIT f
(Ea accident) $
---~ ------------
BODILY INJURY
(Per person) $
~---- - --
OFFICIAL REC ORDS AND
LEGISlATIVE SRVCS DEPT
BODILY INJURY
(Par accident)
$
-- .....
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
, I'~==~ ANY AUTO
~ EXCESS I UMBRELLA liABILITY
L'.] OCCUR D CLAIMS MADE
!
i
t'--l DEDUCTIBLE
i -1 RETENTION $
I'WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
'I ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
( If yes, describe under
I SPECIAL PROVISIONS below
AUTO ONLY - EA ACCIDENT $
_ ._.u__
EA ACC ~__.___.______,__
AGG $
$
EACH OCCURRENCE
OTHER THAN
AUTO ONLY:
AGGREGATE
$
$
.______.__.__u____.
$
__ _________.n._.___..___
$
__ I ~R~T~~~S I I OTHE~_ ____ ____ .
E.L. EACH ACCIDENT $
____.__n__.___.._._.._ _
E.l. DISEASE-EA EMPLOYEE $
.. 1-----------_. _u
E.L. DISEASE-POLICY LIMIT $
i OTHER: SPECIAL FORM HAZARD TBA 08/14106 08/14107
A VALUE. $600,000
80% COINSURANCE
INCLUDES REPLACEMENT COST
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTi SPECIAL PROVISIONS
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS
WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE
TO DO SO SHAll IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.
I1'S AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ~~
Attention: . . Clarkson
ACORD 25 (2001/08)
Certificate #
97965
@ACORD CORPORATION 1988