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CERTIFICATE OF LIABILITY INSURANCE (6) ACORD.. CERTIFICATE OF LIABILITY INSURANCE OP ID D DATE (MMlDDlYYVY) CUHBE-2 03/30/05 THIS CERTIFICATE IS 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 W.llace Welch & Willingham Inc 3bO First Avenue South, 5th Fl P.O. Box 33020 St. Petersburg FL 33733 Phone: 727-522-7777 Fax:727-521-2902 INSURED CWmbey & Fair, Inc. 2463 Enterprise Rd. Clearwater FL 33763 INSURERS AFFORDING COVERAGE INSURER A: Zurich .Insurance Company INSUREA B: A>:c:lal.tec:u IUI4 BDgI....ere x... c INSURER C: INSURER D: INSURER E: NAtC# 16535 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 SEEN REDUCED SY PAID CLAIMS, LTA NSR TYPE OF INSURANCE POUCY NUMBER ~1,fe1MMIlflWif DATE MMlDDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 - A X COMMERCIAL GENERAL LIABILITY PAS42162868 03/16/05 03/16/06 ~~~~~'Es (Ea occurenee) $300,000 I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $10,000 --- PERSONAL & ADV INJURY $1,000,000 --- GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMPIOP AGG $2,000,000 Ii POLICY n ~r8r Ii LOC nC, _n n:::ri EmD Ben. 1,000,000 -.... '\.1 r AUTOMOBILE LIABILITY ,,,- COMBINED SINGLE LIMIT f-- $ ANY AUTO ~ r' f 2QQS (Ea accident) - t\P ALL OWNED AUTOS 1\ ,-I J , BODILY INJURY - $ SCHEDULED AUTOS (Per person) - OFFlCI.A RECORDS :-\N j HIRED AUTOS BODILY INJURY - I,IVE SRVCS i)F"[ $ NON-OWNED AUTOS LEGISLA (Per accident) - - PROPERTY DAMAGE $ (Per accident) GARAGE UABlLlTY AUTO ONLY - EA ACCIDENT $ =1 ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSlUMBRELLA LIABILITY EACH OCCURRENCE $2,000,000 A !J OCCUR o CLAIMS MADE PAS42162868 03/16/05 03/16/06 AGGREGATE $2,000,000 $ ~ DEDUCTIBLE $ X RETENTION $10000 $ WORKERS COMPENSATION AND IT~~y5~~WS I IUE~- EMPLOYERS' LIABILITY E.L EACH ACCIDENT $ ANY PROPRIETORlPARTNERlEXECUTIVE OFFICERlMEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $ ~deSCribe under E.L DISEASE - POLICY LIMIT ..$. At. i>R6VISiONS below -- OTHER B Professional Liab 05-0019801 03/16/05 03/16/08 1,000,000 Each Claim $25,000 Deductible 1,000,000 Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS' VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT' SPECIAL PAQVISIONS RE: Job No: 712B project Name: General and Professional Liability. the City of Clearwater is Additional insured with regard to General Liability. City of Clearwater Risk Management P.O. Box 4748 Clearwater FL 33758-4748 CANCELLATION CX'l'Y -CL SHOULD MY OF THE ABOVE DESCR18ED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WIll ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CER11F/CATE 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 CERTIFICATE HOLDER ACORD 25 (2001/08) @ACORD CORPORATION 1988 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DDIYY) 3/31/05 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR At TER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PPODUCER ACORDIA EAST - TAMPA BAY P.O. Box 31666 Tampa. FL 33631-3666 727-796-6666 INSURERS AFFORDING COVERAGE INSURED Cum bey & Fair. Inc. 2463 Enterprise Road Clearwater FL 33763 INSURER A: INSURER B: INSURER C: INSURER 0: INSURER E: Florida Retail Federation 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 POUCY NUMBER ~~gYII~~~~ ~~~",Y EXPIRATION UMITS GENERAL UABIUTY EACH OCCURRENCE $ - COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ I CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $ PERSONAL III ADV INJURY $ - GENERAL AGGREGATE $ - VED 4'L AGGREn LIMIT APn PER; RECEI PRODUCTS - COMP/OPAGG $ POLICY p,~g;. LOC """ AUTOMOBILE LlABIUTY Z005 COMBINEO SINGLE LIMIT - APR 0 6 $ ANY AUTO (Ea accident) ." - - ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS OFFICIAL REC )RDS AND (Per personl - LEGISLATIVE S VCS D,:q" HIRED AUTOS BODILY INJURY - $ NON-OWNED AUTOS (Per accident) - PROPERTY DAMAGE $ (Per accident) ==iAGE LlABIUTY AUTO ONLY- EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ ~ OCCUR o CLAIMS MADE AGGREGATE $ $ ~ DEDUCTIBLE $ RETENTION $ $ 52024651 3/16/05 3/16/06 X I T"X~iI:lt~s I IOTH- A WORKERS COMPENSATION AND ER EMPLOYERS' LIABILITY E.L EACH ACCIDENT $ 100000 E,L. DISEASE - EA EMPLOYEE $ 100000 E.L. DISEASE - POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXeLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER [ I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION CITY OF CLEARWATER DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN RISK MANAGEMENT NOTICE TO THE CERTIACATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL PO BOX 4748 IMPOSE NO OBLIGATION OR UABIUTY OF ANY KIND UPON THE INSURER. ITS AGENTS OR CLEARWATER FL 33758-4748 REPRESEl'(TATIVES, AUT'Vp /71ACrl. b 1. - V. I J '",", -yo"'\' . V Jl/If/IF . , ACORD 25-S (7/97) 46- 36 @ ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policyliesl must be endorsed. A statement . on this certificate does not confer rights to the certificate holder in lieu of such endorsementlsl. 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 endorsementlsl. DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurerlsl, 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)