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CERTIFICATE OF LIABILITY INSURANCE ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDlYYYY) 1M 06/06/2008 PRODUCER (203) 354-6200 FAX (203)354-6480 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Shoff Darby Companies, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 401 Merritt 7, Plaza Level ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Norwalk, CT 06851 Bethany Gran INSURERS AFFORDING COVERAGE NAIC# INSURED TOWER OPTICAL CO INC INSURER A: Hartford Casualty Insurance Co 29424 275 EAST AVENUE INSURER B: Hartford Underwri ters 30104 EAST NORWALK, CT 06855 INSURER C: Multiple COll1'anies 00914 INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. INSR ADOOL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS ~ERAL LIABILITY 3lSBAKV9492 o 1/0 I/Z008 01/01/2009 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,000 - tJ CLAIMS MADE [!J OCCUR '--- MED EXP (Anv one person) $ 10,000 A PERSONAL & ADV INJURY $ 1,000,000 f.-- GENERAL AGGREGATE $ 2,000,000 ~ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPfOP AGG $ 2,000,000 ~ POLICY n ~~g. n LOC ~TOMOBILE LIABILITY 3lUECIB9357 01/01/Z008 01/01/2009 COMBINED SINGLE LIMIT (Ea accident) $ X ANY AUTO 1,000,000 I-- J ~ECE'VE ALL OWNED AUTOS D! BODILY INJURY I-- (Per person) $ SCHEDULED AUTOS B I-- {- HIRED AUTOS ,UN 3 0 2001 BODILY INJURY (Per accident) $ NON-OWNED AUTOS - OFFIC PROPERTY DAMAGE $ IA! _h (per accident) ...~r =fAGE LIABILITY LEGIS I ~JIVE SRVCS EPT AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO $ fJESSlUMBRELLA LIABILITY 31SBAKV9492 01/01/2008 01/01/2009 EACH OCCURMNCE $ Z,OOO,OOO X OCCUR 0 CLAIMS MADE AGGREGATE $ Z,OOO,OO<l A $ ~ DEDUCTIBLE $ X RETENTION $ 10,oo<l $ WORKERS COMPENSATION AND 3lWECRJl379 01/01/2008 01/01/2009 X I WC STATU-I f 0JlI- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT 500,000 C ANY PROPRIETORlPARTNERlEXECUTlVE $ OFFICERlMEMBER EXCLUDED? E. L. DISEASE - EA EMPLO'fIi $ 500,000 If yes, describe under E. L. DISEASE - POLICY LIMIT 500,000 SPECIAL PROVISIONS below $ OTHER ~ESCRIP;rION OF OPERATIONS f LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS e: P,er 60 ~he City of Clearwater, Marine & Aviation Department are included as additional insured under the ~eneral Liability policy as it relates to operations of the named insured. ~ld Harmless Clause per legal contract ~Except ten (10) days notice of cancellation for non paynent of premiu~ COVERAGES CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEllED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL City of Clearwater 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Marine & Aviation Dept BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 20 Causelay Blvd OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Cl earwater, FL 33767 AUTHORIZED REPRESENTATIVE ~ Cf-- Bethany Gran/GRANB ACORD 25 (2001/08) @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 (2001/08) ACORQ, CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDNYVY) 06/06/2008 PRODUCER (203)354-6200 FAX (203) 354-6480 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Shoff Darby Companies, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 401 Merritt 7, Plaza Level ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Norwalk, CT 06851 Bethany Gran INSURERS AFFORDING COVERAGE NAIC# INSURED TOWER OPTICAL CO INC INSURER A: Hartford Casualty Insurance Co 29424 275 EAST AVENUE INSURER B: Hartford Underwriters 30104 EAST NORWALK, CT 06855 INSURER c: Multiple Companies 00914 INSURER 0: INSURER E: 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~$l~ ~~I?;! TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY 31SBAKV9492 01/01/2008 01/01/2009 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,000 - o CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $ 10,000 - A PERSONAL & ADV INJURY $ 1,000,000 - GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COM PlOP AGG $ 2,000,000 I POLICY n ~~& n LOC AUTOMOBILE LIABILITY 31UECIB9357 01/01/2008 01/01/2009 COMBINED SINGLE LIMIT X- $ ANY AUTO (Ea accident) 1,000,000 - ALL OWNED AUTOS BODILY INJURY - (par person) $ SCHEDULED AUTOS '~fCF'\/f B X- r, HIRED AUTOS BODILY INJURY X- $ NON-OWNED AUTOS ~.j (par accident) - - ~UN 3') 2001 PROPERTY DAMAGE $ (Per accident) ~GE LIABILITY OFFIC AUTO ONLY - EA ACCIDENT $ ANY AUTO AL RECORDS A.ND EA ACC $ LEGISt OTHER THAN ATlVE SRVC~ II=PT AUTO ONLY: AGG $ :KJESSlUMBRELLA LIABILITY 3lSBAKV9492 01/01/2008 01/01/2009 EACH OCCURRENCE $ 2,000,000 X OCCUR D CLAIMS MADE AGGREGATE $ 2.000,000 A $ ~ DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATION AND 3lWECRJ1379 01/01/2008 01/01/2009 X I WC STATlJ- I I oJ: EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 500,000 C ANY PROPRIETOR/PARTNERlEXECUTlVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYB $ 500,000 If yes, describe under E. L. DISEASE - POLICY LIMIT $ 500,000 SPECIAL PROVISIONS below OTHER rf.ESCRIPTIOtl O~ OP:f"TIONSJ LOCATIONS I VEHICLES I EXCLUSIONS ADOED BY ENDORSEMENT I SPECIAL PROVISIONS e: MUnlClpa Marlna he City of Clearwater, Marine & Aviation Department are included as additional insured under the ;oeneral Liability policy as it relates to operations of the named insured. ~old Harmless Clause per legal contract ~Except ten (10) days notice of cancellation for non payment of premiu~ COVERAGES CERTIFICATE HOLDER CANCELLATION SHOULD IU>lY OF THE ABOVE DESCRIBED POLICIES BE CIU>lCElLED BEFORE TlHE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL City of Clearwater ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Marine & Aviation Dept BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABII..ITY 20 Causelay Blvd OF IU>lY KINO UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Clearwater, FL 33767 AUTHORIZED REPRESENTATIVE ~~ Bethanv Gran/GRANB ACORD 25 (2001/08) @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 (2001/08)