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CERTIFICATE OF LIABILITY INSURANCE (84)ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) TM 10/3/2008 PRODUCER Phone: 727 461-6044 Fax: 727 442-7695 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Brown & Brown Insurance - Clearwater ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 2456 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 660 Clearwater FL 33757-2456 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: Hart ford Fire Insurance Co. 19682 Kisinger Campo & Assoc. Corp. INSURERB: Hart ford Casualty Insurance C 29424 KCCS, Inc 400 F kli St t St 201 N INSURER c:Lexington Insurance Co. 19437 ran n ree , e . Tampa FL 33602 INSURER D: INSURER E: 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. INSR ADD'L POLICY NUMBER ICYEFFECTIVE D LATE (MMIDDrM POLICY EX (RATION DATE (MMIDDITY) LIMITS A X GENERAL LIABILITY 21UUNAG7 54 7 9/l/2008 9/l/2009 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $100,000 CLAIMS MADE IX I OCCUR MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OPAGG $2,000,000 X POLICY jPERC0j F-] LOC A X AUT OMOBILE LIABILITY 21UUNAG7547 91 9 1/2009 COMBINED SINGLE LIMIT X ANY AUTO ?I (Ea accident) $ 1,000, 000 ALL OWNED AUTOS BODILY INJURY SCHEDULEDAUTOS _ (? if 00Q (Per person) $ [[JJ X HIREDAUTOS BODILY INJURY NON-OWNEDAUTOS FFICIAL (Per accident) $ RECO RDS AND LE GIS AMAGE PROPERTY LATIVE SR S DEPT cident) (Per a $ GA RAGE LIABILITY AUTO ONLY -EAACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ B X EXCESS/UMBRELLA LIABILITY 21XHUAG7 6 0 7 9/l/2008 9/l/2009 EACH OCCURRENCE $2,000,000 X OCCUR CLAIMS MADE AGGREGATE $2,000,000 $ DEDUCTIBLE $ X RETENTION $10,000 $ A WORKERS COMPENSATION AND 21WBNW1033 10/3/2008 10/3/2009 X WRSTATT OEH- EMPLOYERS' LIABILITY - --- ---. -$ 5 ANY A/EXECOTIV - OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 5 0 0 0 0 0 Ifyes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 5 0 0 0 0 0 C OTHER 0530377 11/2/2007 11/2/2008 Per Claim 2, 000, 000 Professional Liability Aggregate 5,000,000 Claims Made Deductible 200,000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Certificate Holder is an additional insured with respect to general liability, auto liability and umbrella liability. Endorsements available upon request. Waiver of Subrogation applies to general liability and workers compensation. *10 Days for Non Payment. ULK 1 IFIL:A I It HULUtK I:ANI:tLLA I IUN City of Clearwater Attn: City Clerk P O Box 4748 Clearwater FL 33758-4748 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE 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. AUTHORIZED REPRESENTATIVE 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. AGORD 25 (2001/08)