CERTIFICATE OF INSURANCE (245)
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ACORD
TM
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIYYYY)
09/22/2004
THIS CERTIFICA TEIS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER (813)890-0415 FAX (813)885-4311
PrimeGroup Insurance Services, Inc.
5440 Beaumont Center Blvd.
Suite #445
Tampa, Fl 33634
INSURED All Ti n Sheet Metal & Roofi ng, Inc
7826 Rhodes Rd.
Hudson, Fl 34667
INSURERS AFFORDING COVERAGE
NAIC#
INSURER A AmCOMP Preferred Ins. Co.
INSURER B:
INSURER C:
INSURER D:
INSURER E:
CQVERAGES/c -~~~< ---,- ----
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTAND
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 sue
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
II~~G N~~i TYPE OF INSURANCE POLICY NUMBER DATE IMM/DDIYVl DATE IMM/DDIYY\ LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
r-- ~~~~~~~ YE~~~nce\
COMMERCIAL GENERAL LIABILITY $
I CLAIMS MADE D OCCUR MED EXP (Anyone person) $
PERSONAL & ADV INJURY $
r--
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COM~OPAGG $
n 'nPRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
r-- (Ea accident) $
ANY AUTO
r--
ALL OWNED AUTOS BODILY INJURY
f-- (Per person) $
SCHEDUL!':D AUTOS
r--
HIRED AUTOS BODILY INJURY
f-- $
NON-OWNED AUTOS (Per accident)
r--
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESs/UMBRELLA LIABILITY EACH OCCURRENCE $
tJ OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND WCV7047337 09/18/2004 09/18/2005 I TORY LIMITS I IU~~-
EMPLOYERS' LIABILITY I,OOO,OO(
A ANY PROPRIETOR/PARTNER/EXECUTIVE E:L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E: L. DISEASE - EA EMPLOYE $ I,OOO,OO(
If yes, describe under I,OOO,OO(
SPECIAl PROVISIONS below E:L. DISEASE - POLICY LIMIT $
OTHER
.- -'-'-- ------ ----~ --- .-.-.------:.----~- -I----c------ < f-- - -- -~.._,,- ---'-~ -- ----.---.-- --._------ f-
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Clearwater
2741 SR 580
Clearwater, Fl 33761
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILENDEAVOR TO MAIL
JL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES,
AUTHORIZED REPRESENTATIVE
Deborah A. Ski
er
~oJ--....(}.., ~
#A244621/.>RI
@ACORD CORPORATION 1988
ACORD 25 (2001/08)
.
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 suchendorsement(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.
f---
ACORD 25 (2001/08)