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ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYVY)
12122/04
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
BWD Group LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
BWD Plaza, P.O. Box 9050 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
113 South Service Road
Jericho, NY 11753 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: American Home Assurance Company
Bright House Networks, LLC. INSURER B: St, Paul Fire & Marine Insurance Co. ...
700 Carillon Parkway. Ste 1 INSURER c: ' .
St. Petersburg, Florida 33716 INSURER D:
INSURER E: .
Client#. 2242
BRIGHOUS
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,
INSR ~~~~ PJ>l-~~~~~~g~>>~,E Pg~fl'~~/~t~I~N
LTR TYPE OF INSURANCE POLICY NUMBER LIMITS
A ~NERAL LIABILITY 6007622 01/01/05 01/01/06 EACH OCCURRENCE $2 000 000
1L ==fMERCIAL GENERAL LIABILITY ~~~b~~JO RENTED $1 000000
- CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $Excluded
- PERSONAL & ADV INJURY $2 000.000
GENERAL AGGREGATE $20,000 000
-
~'L AGGREAELlMIT APPlS PER: PRODUCTS - COM PlOP AGG $2 000 000
, PRO- Per Loc Arm $4 000 000
POLICY JECT LOC
A ~OMOBILE LIABILITY 2045001 01/01/05 01/01/06 COMBINED SINGLE LIMIT
2L ANY AUTO (Ea accident) $2,000,000
2L ALL OWNED AUTOS BOOIL Y INJURY
$
2L SCHEDULED AUTOS (Per person)
2L HIRED AUTOS BODILY INJURY
, $
2L NON-OWNED AUTOS (Per accident)
- PROPERTY DAMAGE $
(Per accident)
~AGE LIABILITY AUTO ONLY. EA ACCIDENT $
ANY AUTO OTHER THAN EA ACe $
AUTO ONLY: AGG $
B ~~SS/UMBRELLA LIABILITY QK06500318 01/01/05 01/01/06 EACH OCCURRENCE $5 000 000
X OCCUR D CLAIMS MADE AGGREGATE $5 000 000
$
~ ~EDUCTIBLE $
X RETENTION $ 10.000 $
A WORKERS COMPENSATION AND 5899150,51,52 01101/05 01/01/06 X T WC STATU- I IOJ~'
EMPLOYERS' LIABILITY $1,000,000
ANY PROPRIETOR/PARTNERlEXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E.L. DISEASE. EA EMPLOYEE $1,000,000
If yes, describe under__ _ --"'---="'-'- -' ___-__,,___ __,~_, _c__ _. - ___~ I... - -~ -- , $f,oOOOOO -
.... SPB::fA[PRO\7fSIONS below .--- E.L. DISEASE - POLICY LIMIT
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Re: 2530 Drew Street, Clearwater, FL 34625
Certificate holder is included as additional insured,
CERTIFICATE HOLDER
CANCELLATION
City of Clearwater
112 South Oscala Ave,
Clearwater, FL 34616
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE.THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -3fL. 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
~~
DIKES @ ACORD CORPORATION 1988
ACORD 25 (2001/08) 1 of 2
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