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CERTIFICATE OF LIABILITY INSURANCE (15)f`lienH!- RA191 1(:1 f1R.qPF ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE 04 /06/09D PRODUCER Willis of Pennsylvania, Inc. 600 W. Germantown Pike -° w- a 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. Suite 300 Plymouth Meeting, PA 19462-9 1 APR I -? INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Great Divide Insurance Company 25224 Global Spectrum, L `. INSURER B: Nautilus Insurance Co. 17370 3601 S. Broad Street' INSURER C: Philadelphia, PA 19148 INSURER D: INSURER E: PnVPPAnPQ 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 POLICY EFFECTIVE DATE (MMIDDIYY) POLICY EXPIRATION DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ . COMMERCIAL GENERAL-LIABILITY -._? __.. _,-----------------•_.. _. --..-__-- _ .-- .: .. __. - . ._.. ..DAMAGE TO RENTED PREMISES (Ea occurrence) ..- -$-...., CLAIMS MADE ? OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ LICY PRO CT LOC PO JE AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ 1 E AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1 OCCUR FICLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ H RETENTION $ $ A WORKERS COMPENSATION AND WCA103669410 (AOS) 03/30/09 03/30/10 X WC STATU- O7H- TQRY S I Eee_ L0.,._..5r..L!n8t .. _. ?A1if3'669-3T? 03/30/09 E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 OTHER REuEIVEu DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS FL 33755 APR 1 3 2009 0 l l d St t Cl t eve an ree ; earwa er, Re: Harborview Center; 30 C City of Clearwater, Florida is included as Additional Insured where RISK MANAGEMENT required by contract, solely with respect to the operations of the Named Insured. GERIIFICATE MULDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF CLEARWATER DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 112 S. OSCEOLA AVENUE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL CLEARWATER, FL 34618-0000 I IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR (E : n.Ga??` Pa"'-? REPRESENTATNES. AUTHORIZED REPRESENTATIVE ACORD 26 (2001/08) 1 of 2 #M444665 1JVAN Q 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 2545 (2001/08) 2 of 2 #M444665 f' l:...." 4A']C'] 9 f:1 nrtCaP ACORUM CERTIFICATE OF LIABILITY INSURANCE DATE 04 /06/09D ) PRODUCER Willis of Pennsylvania, Inc. r- _ - - - -. --- - ro 600 W. Germantown Pike - ' - !-j ='-. 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. - Suite 300 Plymouth Meeting, PA 19462-9998 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER As Great Divide Insurance Company 25224 Global Spectrum LP INSURER B: Nautilus Insurance Co. 17370 3601 S. Broad Stigeet ,.. INSURER c: Gemini Insurance Company 10833 Philadelphia, PA 19148 INSURER D: Philadelphia Insurance Co 18058 INSURER E: f`n\/CDAf_CC 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- 1 S LTR D' NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE D T POLICY EXPIRATION DATE (MMIDDIYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ OMM-ERCIAL GENERAL HABI _-I--TY-. . - - - DAMAGE FO-RENTED- - - ._... PREMISES (Fa occurrence) _ ..,... -.___-- _ . $ CLAIMS MADE D OCCUR MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO- LOC JEC7 D AUTOMOBILE LIABILITY PHPK355928 10118/08 10/18/09 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY, AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION AND WCA103669410 (AOS) 03/30/09 03/30/10 X WTORX C LIMIT DFH- - FMP1oYERKL1ABluTY-.-_-..-. WCAM36693TOTAZY 0 /09 03/30/10 E.L. EACH ACCIDENT $1000000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 C OTHER Professional VPPL002485 04/01/09 04/01/10 $3,000,000 Limit Liability $5,000 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS RE: Harborview Center, 300 Cleveland Street, Clearwater, FL 33755 RECEIVED City of Clearwater is included as Additional Insured solely with respect APR 13 2009 to the operations of the Named Insured for Auto Liability as required by signed contract. RISK MANA(;FU;:hij City of Clearwater 112 S. Osceola Avenue Clearwater, FL 34618 04,1 ck-)? ce_L V1.66 fu. l sLL 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 $O SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) 1 of 2 #M444670 1JVAN O 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(sr 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 #M444670