CERTIFICATE OF LIABILITY INSURANCE (22) DATE(MM/DDYYY)
A�" /YCERTIFICATE OF LIABILITY INSURANCE 3/31/2023
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 AgencyP HONE FAX
315 W. Fletcher Ave. A/C No Ext): 813-933-6691 A/C,NO)7 813E-M -932-6287
Tampa 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: Great American Ins. Co. 16691
4314 West Dr Martin Luther King Jr Boulevard
Tampa FL 33614 INSURER D: Oak River Insurance Company 34630
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:1746864450 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 POLICY NUMBER MM/DD MM/DD
B X COMMERCIAL GENERAL LIABILITY SCGL005000017500 2/28/2023 2/28/2024 EACH OCCURRENCE $1,000,000
DAMAGE S( RENTED
CLAIMS-MADE OCCUR
PREMISES Ea occurrence)
ccurrence) $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 1:1 LOC PRODUCTS-COMP/OP AGG $2,000,000
OTHER: $
D AUTOMOBILE LIABILITY 04TRM05063001 2/28/2023 2/28/2024 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 LAB X OCCUR SXCS005000004100 2/28/2023 2/28/2024 EACH OCCURRENCE $4,000,000
EXCESS LAB CLAIMS-MADE AGGREGATE $4,000,000
DED RETENTION$ $
A WORKERS COMPENSATION WC10000165972022A 11/2/2022 11/2/2023 X PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $1,000,000
OFFICE R/M EMBER 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
C Armored Car Cargo Liab-Crime ACE831866 4/3/2023 4/3/2024 Any One Accident 2,000,000
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
City Of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Customer Service Director
Customer Service Department AUTHORIZED REPRESENTATIVE
P O Box 4748
Clearwater FL 33758
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