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CERTIFICATE OF LIABILITY INSURANCE (67)Client#: 115295 FAMISER2 ACDRDTM CERTIFICATE OF LIABILITY INSURANCE DATE L D/YYYY) 1/10/08 1 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Wachovia Insurance Serv-TA, FL ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4600 W Suite 200 Cypress St HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR . , ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 25277 (Zip 33622) Tampa, FL 33607 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: American States Insurance Company 19704 'amf / Oiervice Centers, Inc. INSURER B: Arch Specialty Insurance Company 21199 2960 Roosevelt Blvd INSURER C: Clearwater, FL 34620 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. I POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS A GENERAL LIABILITY 01 CH27763220 10/01/08 15 ;?Q4 EACH OCCURRENCE $1 000 OOp X COMMERCIAL GENERAL LIABILITY DAREMIS ES (Ea MAGE To RENTED n $1,000,000 CLAIMS MADE FX1 OCCUR MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE s3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s3,000,000 7 POLICY PROJECT LOC A AUT OMOBILE LIABILITY 24CC20592310 10/01/08 10/01/09 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER FHAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY 01SU38597320 10/01/08 10/01/09 EACH OCCURRENCE $1,000,000 - 1 CLAIMS MADE X OCCUR F AGGREGATE $110001000 DEDUCTIBLE $ X RETENTION $ 10000 $ W S OTH- WORKERS COMPENSATION AND LIMIT Y T EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE --- -- _ - "-- _ --- -. E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ B OTHER Commercial P ESP002957700 10/01/08 10/01/09 I DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate holder is additional insured regarding general liability. ter l i l i 6 2008 City of Clearwater, City Hall Michael Holmes, Housing Manager 112 South Osceola Avenue Clearwater, FL 33756 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 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 J ACORD 25 (2001/08) 1 of 2 #M1419604 CSC02 © ACORD CORPORATION 1988 1 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-S (2001/08) 2 of 2 #M1419604