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CERTIFICATE OF LIABILITY INSURANCE (7) ., ACORDN CERTIFICATE OF LIABILITY INSURANCE OP ID D DATE (MMlDDIYYYV) CUMBE-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 Wallace Welch & willingham Inc 300 First Avenue South, 5th Fl P.O. Box 33020 St. Petersburg FL 33733 Phone: 727-522-7777 Fax:727-521-2902 INSURED INSURERS AFFORDING COVERAGE Cumbey & Fair, Inc. 2463 Enterprise Rd. Clearwater FL 33763 INSURER A: INSURER B: INSURER C: INSURER D: INSURER E: Zurich Insurance Company NAIC# 16535 Architects and Engineers Zns C 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. LTR NSR[ TYPE OF INSURANCE POLICY NUMBER ~,;!~1:~J~tWlE . PQ~!CEY(~:lRPlgN LIMITS DATE MMlDDIYY GENERAL LIABILITY EACH OCCURRENCE $1,000,000 f-- A ~ COMMERCIAL GENERAL LIABILITY PAS42162868 03/16/05 03/16/06 ~~~~~~S (Ea occurence) $ 300,000 ~ CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 10,000 f-- PERSONAL & ADV INJURY $ 1,000,000 f-- GENERAL AGGREGATE $ 2,000,000 f-- . -- --- GEN'L AGGREGATE LIMIT APPLIES PER: - -- ------------ - . .. - ---- - PRODUCTS.COM~OPAGG $ 2,000,000 n-------h .. .........-rr- - PRO. Emp Ben. 1,000,000 POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT f-- (Ea accident) $ ANY AUTO f-- ALL OWNED AUTOS BODILY INJURY f-- $ SCHEDULED AUTOS (Per person) f-- HIRED AUTOS BODILY INJURY f-- (Per accident) $ NON.OWNED AUTOS f-- f-- PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY.. EA ACCIDENT $ R ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSlUMBRELLA LIABILITY EACH OCCURRENCE $ 2,000,000 A t!J OCCUR D CLAIMS MADE PAS42162868 03/16/05 03/16/06 AGGREGATE $ 2,000,000 $ Fx=1 DEDUCTIBLE $ X RETENTION $10000 $ WORKERS COMPENSATION AND ITg~/~I~:~S I IU~~' EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $ - If yes, describe under ....-.. ....- ..'.. ELDlSEASE.-PQUCY LIMIT .$. -,,- -sf'EClAtf'ROlflSl0NS below c--....... - .. .... I. ....... . ...... ..... -- ___. m .. .. ... 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 I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RE: Job No: 712B Project Name: General and Professional Liability. the City of Clearwater is Additional insured with regard to General Liability. CERTIFICATE HOLDER CANCELLATION City of Clearwater Risk Management P.O. Box 4748 Clearwater FL 33758-4748 CITY -CL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIRCATE 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 REPRESENTATIVES. AUTHORIZE ES @ ACORD CORPORATION 1988 ACORD 25 (2001/08) . ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DD/YYI 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 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ~'ODUCER ACaRDIA EAST - TAMPA BAY P.O. Box 31666 Tampa, FL 33631-3666 727-796-6666 INSURERS AFFORDING COVERAGE INSURED Cumbey & Fair, Inc. 2463 Enterprise Road Clearwater FL 33763 INSURER A: INSURER B: INSURER C: INSURER D: 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 POLICY NUMBER ~~~~YJ~~g~T~~~ P8k!fEY(~~J~~~~~ LIMITS ~ERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE IAny one firel $ I CLAIMS MADE D OCCUR M ED EXP IAny one person) $ PERSONAL & ADV INJURY $ - GENERAL AGGREGATE $ - GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ I POLlCyn ~~~T nLOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT - $ ANY AUTO lEa accidentl - ALL OWNED AUTOS BODILY INJURY - $ SCHEDULED AUTOS IPer personl - - HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS IPer accidentl - - PROPERTY DAMAGE $ IPer accidentl GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ~ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ =:J OCCUR D CLAIMS MADE AGGREGATE $ $ ~ DEDUCTIBLE $ - . -- $ RETENTION $ .. _. --- .-- - 52024651 3/16/05 3/16/06 IWC STATU., I IOTH- A WORKERS COMPENSATION AND X TORY LIMITS ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 100000 E.L. DISEASE - EA EMPLOYEE $ 100000 E.L. DISEASE - POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATlONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS 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 ---2Q.. DAYS WRITTEN RISK MANAGEMENT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL PO BOX 4748 IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR CLEARWATER FL 33758-4748 REPRESEI\ITATIVES, AUTWd 11~. ~/"YIA'VJ L - I L/ \.y. V..Q~ . , ACORD 25-S (7/97) 46- 36 @ ACORD CORPORATION 1988 ~ .: IMPORT ANT 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(sl. 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 25-8 (7/97)