CERTIFICATE OF LIABILITY INSURANCE (52)
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE IMM/DD/YY)
12/26/07
PRODUCER 727-796-6666 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wells Fargo Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Southeast, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 31666 RECEIVED
Tampa, FL 33631-3666 INSURERS AFFORDING COVERAGE
INSURED ,-~" ( .-. ')001 INSURER A: HARTFORD INSURANCE GROUP
Image One ~ _OJ ,. ...' ...u
Image One Corp dba INSURER B:
6206 Benjamin Rd #301 .. \ ....CORP~.^~ IflI\ISURER c:
( l{t ,.J.' t~SURER 0:
;rampa FL 33634 'VC 0[:
L~'-""'" ;;II'< oJ ....
t ,.' . 'I", , INSURER E:
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~;: TYPE OF INSURANCE POLICY NUMBER ~9N~rJ~~%~"~ Pgk!fl EXPIRATION LIMITS
A GENERAL LIABILITY 21SBALl1614 1/01/08 1/01/09 EACH OCCURRENCE $ 1000000
f--
c-X- 3MMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ 300000
CLAIMS MADE W OCCUR MED EXP (Anyone personl $ 10000
f--
PERSONAL & ADV INJURY $ 1000000
GENERAL AGGREGATE $ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG $ 2000000
n POLICY n P,~,Q;. n LOC
A AUTOMOBILE LIABILITY 21 UECLl4905 1/01/08 1/01/09 COMBINED SINGLE LIMIT
- $ 1000000
~ ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
L HIRED AUTOS BODILY INJURY
$
L NON-OWNED AUTOS IPer accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
==i ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A EXCESS LIABILITY 21SBALl1614 1/01/08 1/01/09 EACH OCCURRENCE $ 1000000
~ OCCUR D CLAIMS MADE AGGREGATE $ 1000000
$
~ DEDUCTIBLE $
X RETENTION $ 10000 $
A WORKERS COMPENSATION AND 21WECDU9811 1/01/08 1/01/09 I WC STATU-I 10TH-
X TORY LIMITS ER
EMPLOYERS' LIABILITY
.. .. .... - -_.--- .. ~- -E:t~eH -;>;CeIDENT $ - 100000lJ-
E.L. DISEASE. EA EMPLOYEE $ 1000000
E.L. DISEASE - POLICY LIMIT $ 1000000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER IS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF CLEARWATER DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ---1Q..
DAYS WRITTEN
A TT: CITY CLERK NOTICE TO THE CERTIACATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
POBOX 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
CLEARW A TER FL 337584748 REPRESENTJlIffVES. /J ~
AUTH~!JP~V/
I
ur
ACORD 25-S (7/97) 45- 38 * f/ V I @ 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.
ACORD 25-5 (7/97)