CERTIFICATE OF LIABILITY INSURANCE (28) g
ACC)RL> CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YY'
02/17/2020
THIS CERTIFICATE IS ISSUED ASA 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(ies)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 CONTACT
RAW- Carol Wiggin
Fulton Agency,Inc. PHONE
L ,Exl (954_)776-9015 (954)752-8622
1301 E.Oakland Park Blvd E-MAIL carol f
ADDRESS:___ @ ultonagency.com
INSURER(S)AFFORDING COVERAGE NAIC#
Oakland Park FL 33334 INSURER A: Ategrity Specialty Ins Co
—....
INSURED _INSURER
JRM Science Enterprises Inc INSURER C:
Mad Science Of Greater Tampa Bay INSURER D:
204 37th Ave No#123 INSURER E:
-— —.........
St Petersburq FL 33704 INSURER F:
COVERAGES CERTIFICATE NUMBER: 2697 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INS.RR TYPE OF INSURANCE i
ADDL'St18R?__-- --- -__-- POLICY EFF POLICY EXP
POLICY NUMBER MM/DD/Y'YYY MMIDD LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
-
CLAIMS-MADE [� DAMAGE TO RENTED OCCUR PREMISES(Ea occurrence) $ 100,000
MED EXP(Any one person) $ 5,000
A CCP879824 02/14/202002/14/2021 PERSONAL&ADV INJURY $ 1,000,000
�G/EN'LAGGREGATELIMITAPPLIESPER, GENERAL AGGREGATE $ 2,000,000
/� POLICY PRO- LOC PRODUCTS-COMPIOP AGG $ 1,000,000
OTHER: $
AUTOMOBILE LIABILITY '', -COMBINED SINGLE LIMIT $
Ea aec
ANY AUTO BODILY INJURY(Per person) $
OWNEDSCHEDULED BODILY INJURY
AUTOS ONLY L
AUTOS (Per accident) $
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
$
UMBRELLALIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB 1---- CLAIMS-MADE AGGREGATE $
DED RETENTION$
WORKERS COMPENSATION
AND EMPLOYERS'LIABIU Y Y t N STATUTE -,. ER"
..,._. —_
E.L. ACH ACCIDENT $
OFICERIBERMFandatoM m NH EXCLUDED? El
I A _._ _ _ ----
ANYPROPRIETORIPARTNERIEXECUTIVE !,
( rY ) ---..._-----
EL DISEASE-EA EMPLOYEE:$
If yes,describe under -- ---- --- ---
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
I
DESCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES(ACORD 101,.Additional Remarks Schedule,may be attached if more space Is required)
same and temporary work sites elsewhere in the state of Florida
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Clearwater Public Library System ACCORDANCE WITH THE POLICY PROVISIONS.
100 N Osceola Ave AUTHORIZED REPRESENTATIVE
Clearwater FL 33755 -
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