CERTIFICATE OF LIABILITY INSURANCE (2)
ACORD~ CERTIFICATE OF LIABILITY INSURANCI;LA8t~~ ar1 DATE (MMlDDNY)
01/20/03
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Bouchard-Starcrest ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
101 Starcrest Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P o Box 6090 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater FL 33758-6090
Phone: 727-447-6481 Fax:727-449-1267 INSURERS AFFORDING COVERAGE
INSURED INSURER A: AMERICAN STATES INSURANCE CO
INSURER B: AUTO OWNERS INSURANCE CO
Black Tie Janitorial Services INSURER C: -..... ,rr\
Attn MsKelly Brickfield '"'-
PO Box 13 INSURER D: I" r \lel V L-IJ
Safety Harbor FL 34695
I iNSURER E:
COVERAGES .' Int ') ? "lnn')
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWI STAN ING""'''' ... LVV~
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSU DOR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN is SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITION OF S' b,
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Olrtrr 2. "i1~;nt
INSR ~~~lfrM~&5w::.YE P6'Al{~~~6~J.WN "" .
LTR TYPE OF INSURANCE POLICY NUMBER
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
I--
A ~ COMMERCIAL GENERAL LIABILITY 01CG1498222 03/02/03 03/02/04 FIRE DAMAGE (Anyone fire) $ 200000
~ CLAiMS MADE [!] OCCUR MED EXP (Anyone person) $ 10000
I--
PERSONAL & ADV INJURY $ 1000000
I--
GENERAL AGGREGATE $ 2000000
I--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2000000
n nPRO- n
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000
I-- (Ea accident)
B ANY AUTO 4379519400 03/02/03 03/02/04
I--
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
- HIRED.AUTOS BODILY INJURY
(Per accident) $
NON'OWNED AUTOS
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCiDENT $
==1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AGGREGATE $
$
==1 DEDUCTIBLE I $
I
RETENTION $ $
WORKERS COMPENSATION AND I TORY LI M ris IU~~-
EMPLOYERS' LIABILITY EL EACH ACCIDENT $
- .- -- -- ~--- - _c"______ - .-- ~ I. ~ ------- --- ~-~ -~ 1_ __c_ --- ------" -EL DISEASE - EA EMflLDY-EE -$ -~ ~~ '-- --
EL DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
JANITORIAL SERVICES
CERTIFICATE HOLDER I N I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
CITOCLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL .J.L DAYS WRITTEN
CITY OF CLEARWATER NOTICE TO THE CERTiFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
ATTN: TED STRAND IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
1900 GRAND AVE
CLEARWATER FL 33765 REPRESENIATIVES,
I AUTHORf!y~
ACORD 25-8 (7/97)
@ACORDCORPORATION 1988