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CERTIFICATE OF LIABILITY INSURANCE (2)rlionte. 79x9 RRIr.I4f)1IS ACORD, CERTIFICATE OF LIABILITY INSURANCE 01/05/2009YYY) PRODUCER BWD Group LLC BWD Plaza, P.O. Box 9050 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. 113 South Service Road Jericho, NY 11753 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A. National Union Fire Ins Co Pittsburg Bright House Networks, LLC. INSURER B: St. Paul Fire & Marine Insurance Co. 700 Carillon Pkwy., Suite 6 INSURER C: Illinois National Insurance Company St. Petersburg, FL 33716 INSURER D: New Hampshire Insurance Company 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. INSIR LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DWYY? POLICY EXPIRATION D /Y LIMITS A GENERAL LIABILITY 6506280 01/01/09 01/01/10 EACH OCCURRENCE $2000000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) $1,000,000 CLAIMS MADE 510CCUR MED EXP (Any one person) $EXCLUDED PERSONAL & ADV INJURY $2,000,000 GENERAL AGGREGATE $29,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY PRO JECT LOC Per Loc A $4,000,000 A AUTOMOBILE LIABILITY 6506139 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $2,000,000 ALL OWNED AUTOS -' BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIREpAUTOS I JAN, 2 ' , ?! 009 BODILY INJURY ~ $ X NON-OWNED AUTOS f (Per accident) - PROPERTY DAMAGE -- $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ H ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: -AGG $ B EXCESSIUMBRELLA LIABILITY QK06502079 01101/09 01/01/10 EACH OCCURRENCE $5000000 X OCCUR FICLAIMS MADE AGGREGATE $5,000,000 DEDUCTIBLE $ X RETENTION $10,000 $ A WORKERS COMPENSATION AND 3566666 01 /01 /09 01/01110 1 OTH- X WC STA .T F C EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE 3566667 01/01/09 01/01/10 E.L. EACH ACCIDENT $1,000,000 D" OLFICERNEMBEREXCLUDED7-` - a5j66ff8 - - Q1/Q1/09 01/O7Y70- --- E.L. DISEASE-EA EMPLOYEE _ $1,000,000----- it yes, describe under SPECIAL PROVISIONS below E,L. DISEASE -POLICY LIMIT 1$1,000,000 OTHER . DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Re: 2530 Drew Street, Clearwater, FL 34625 \G : C 11 TIA C uc- 21- Certificate holder is included as additional insured as per written contract or agreement. I.GK 1 IrII,A 1 G nULUGK City of Clearwater 112 South Oscala Ave Clearwater, FL 34616 '1 M..,' t.., . '? I•M SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3()_ 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 ??? (V REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) 1 of 2 #M69595 CACAT © ACORD CORPORATION 1988 s ? 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 (2001108) 2 of 2 #M69595