CERTIFICATE OF LIABILITY INSURANCE (19) 74/5/2022
E(MM/DD/YYYY)
A�" CERTIFICATE OF LIABILITY INSURANCE
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(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
NAME: Andrea J Raab, CIC
Adcock-Adcock Insurance Agency PHONE FAX
315 W. Fletcher Ave. A/C No Ext): 813-933-6691 A/C,No)7 813-932-6287
E-MTampa FL 33612-3414 ADDRESS: AndreaR@adcock-insurance.com
INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA: Michigan Comm. Insurance Co. 10998
INSURED 43674 INSURER B: Summit Specialty Ins. Co. 16889
Mid Florida Armored &ATM Services Inc. INSURERC: Continental Divide Insurance Co. 35939
4314 West Dr Martin Luther King Jr Boulevard
Tampa FL 33614 INSURER D: Great American Ins. Co. 16691
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:1122665200 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.
INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICYNUMBER MM/DD MM/DD
B X COMMERCIAL GENERAL LIABILITY SCGL0050000017500 2/28/2022 2/28/2023 EACH OCCURRENCE $1,000,000
CLAIMS-MADE OCCUR DAMAGE TO RENTED
PREMISES Ea occurrence $100,000
MED EXP(Any one person) $5,000
PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
PRO-
POLICY� ECT 1:1 LOC PRODUCTS-COMP/OP AGG $2,000,000
OTHER: $
C AUTOMOBILE LIABILITY 05TRM04337901 2/28/2022 2/28/2023 COMBINED SINGLE LIMIT $1,000,000
Ea accident
ANY AUTO BODILY INJURY(Per person) $
OWNED X SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
PIP $10,000
B X UMBRELLA LIAB X OCCUR SXCS005000004100 2/28/2022 2/28/2023 EACH OCCURRENCE $4,000,000
EXCESS LAB CLAIMS-MADE AGGREGATE $4,000,000
DED X RETENTION$n $
A WORKERS COMPENSATION WC10000165972021A 11/2/2021 11/2/2022 X PEROTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? ❑ N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
D Armored Car Cargo Liab ACE831866 4/3/2022 4/3/2023 Any One Accident 2,000,000
Ded 25,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City Of Clearwater
100 South Myrtle Avenue AUTHORIZED REPRESENTATIVE
Clearwater FL 33756
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