CERTIFICATE OF LIABILITY INSURANCE (42)
A CORD_ CERTIFICATE OF LIABILITY INSURANCE OP 10 011 DATE (MMfDDNYYY)
CREA IS 07/19/07
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Bouchard-Clearwater ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE I
.101 Starcrest Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR i
POBox 6090 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. i
Clearwater FL 33758-6090
Phone:727~447-64S1 Fax:727-449-1267 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Amerisure Insurance Company 19488
Creative Mailbox Designs LLC
Creative Mailbox &Si~n Designs INSURER B Amerisure Mutual Insurance Co 23396
Creative Mailbox Cen ral FL INSURER c:
FLAluminum Products Inc
12801 Commodity PI INSURER D:
TAMPA FL 33626
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 TO All THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
LTR NSRI TYPE OF INSURANCE POLICY NUMBER ~'4~1MMIDDIY'iI DATE' fMMlDDNYI LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
- OS/01/07 01/01/08 UAMAut; I U "".., "u
A X COMMERCIAL GENERAL LIABILITY GL2030978 PREMISES (Ea occurence) $300,000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5,000
X CONTRACTUAL LIAB PERSONAL & ADV INJURY $ 1,000,000
-
XCU NO DEDUCTIBLE GENERAL AGGREGATE $ 2,000, 000
-
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPfOP AGG $ 2,000,000
I POLICY Iil jrc?,: n LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $1,000,000
A X ANY AUTO CA2030980 OS/01/07 01/01/08 (Ea accident)
-
ALL OWNED AUTOS RECEI WED BODILY INJURY
- $
SCHEDULED AUTOS (Per person) !
-
X HIRED AUTOS BODILY INJURY
- AUG 2 1 7007 (Per accident) $
~ NON-OWNED AUTOS
-.. PROPERTY DAMAGE $
JI-I-I( .. .- (per accident)
GARAGE LIABILITY lEGISLATIVE SR\ CS DEPT AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,000
A ~ OCCUR o CLAIMS MADE CU2030977 OS/01/07 01/01/08 AGGREGATE $5,000,000
$
:1 DEDUCTIBLE $
X RETENTION $10,000 $
WORKERS COMPENSATION AND xl TORY LIMITS 1 IUJ~'
B EMPLOYERS' LIABILITY WC20414360002 01/01/07 01/01/0S' $1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE ELEACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $1,000,000
If yes, describe under E.L DISEASE - POLICY LIMIT $1,000,000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
CITY OF CLEARWATER
PARKS & RECREATION DEPARTMENT
100 SOUTH MYRTLE AVE
CLEARWATER FL 33756
CANCELLATION
CITYCLW SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 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, ITS AGENTS OR
REPRESENTATIVES,
AUTHOR EP SENTA
@ACORDCORPORATlON 1988
CERTIFICATE HOLDER
ACORD 25 (2001/08)