CERTIFICATE OF LIABILITY INSURANCE (48)
,...'
ACORD", CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY)
11108/07
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
BB& Tiler Wall & Shonter ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
800 49th Street North HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 14448
St Petersburg, FL 33733 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A' Hartford Fire Insurance Company 19682
Climate Design Air Conditioning Inc INSURER B: Ohio Casualty Insurance Company 24074
PO Box 48 INSURER C: FFVA Mutual Insurance Company 10385
Pinellas Park, FL 33780 INSURER D: Massachusetts Bay Ins. Co. 22306
INSURER E:
Client#: 902793
69CLlMADES
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.
I~T5: DO' PJ>A~~1~~~&W1E Pg~fJ {~~~~W\N
NSR TYPE OF INSURANCE POLICY NUMBER LIMITS
A GENERAL LIABILITY 21 UENTE0823 11/08/07 11/08/08 EACH OCCURRENCE $1 000000
- ~~~~~~~9E~~~Jl~~n '0'
~ COMMERCIAL GENERAL LIABILITY $300 000
- =:J CLAIMS MADE [Xl OCCUR MED EXP (Anyone person) $10000
~ PO Ded:1,OOO PERSONAL & ADV INJURY $1 000.000
GENERAL AGGREGATE $2 000.000
-
~'L AGGRE~E LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2 000 000
X PRO- n
POLICY JECT LOC
0 ~TOMOBILE LIABILITY ADJ846455000 11/08/07 11/08/08 COMBINED SINGLE LIMIT
~- ANY AUTO RECf/\l (Ea accidenl) $1,000,000
""0
1L ALL OWNED AUTOS Co$' "
", ,_........t BODILY INJURY $
1L SCHEDULED AUTOS (Per person)
. .
1L ' ~-~ ,"" ,
HIRED AUTOS
( ~"/ .- ; BODIL Y INJURY $
1L NON-OWNED AUTOS (Per aceldenl)
1L Drive Other Car '" PROPERTY DAMAGE
'., ,~, '. ',.' (Per accident) $
..>'~ I ,-. ".
=rAGE LIABILITY . -'., AUTO ONL Y , EA ACCIDENT $
,
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
B ~ESS/UMBRELLA LIABILITY EU00853564364 11/08/07 11/08/08 EACH OCCURRENCE $4 000.000
X OCCUR D CLAIMS MADE AGGREGATE $4 000.000
$ --
~ DEDUCTIBLE $
X RETENTION $0 $
C _ \'VORlq;~sCOMf'ENSATION AJl!Duc - WC840001832.62Ol}1A- o 1J~1/0-1-- (}'1-IMm8- ---- . X J WC,STATU- -m~ -
--
EMPLOYERS' LIABILITY $1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT
N OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $1,000,000
If yes, describe under EL DISEASE - POLICY LIMIT $1,000,000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
CERTIFICATE HOLDER
CANCELLATION
CITY OF CLEARWATER
POBOX 4748
CLEARWATER, FL 34618
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ----1D- 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
ACORD 25 (2001/08) 1 of 2
#M2283617
PRLA
@ ACORD CORPORATION 1988
,.
!'
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
_u_ _._ .' ____
ACORD 25-5 (2001/08)
2 of2
#M2283617