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CERTIFICATE OF LIABILITY INSURANCE (106)ACORD CERTIFICATE OF LIABILITY INSURANCE DATE 2009' PRODUCER (770) 552-4225 FAX: Ames and Gough 450 Northridge Parkway 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 102 Atlanta GA 30350 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A:Beazle Insurance Company McKim & Creed, P.A. INSURER B: 243 North Front Street, POB 806 INSURERC: INSURER D: Wilmington NC 28402 INSURER E: QYERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING AN 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 B Q BY PAID CLAIMS, INSR ADD'L TYPE OF INSURANCE POLICY NUMBER PDATEYMWDD/YYE POLICY MMDDfYY) LIMITS .EJ315L LIA8111TY?-..._?._._. - - NCB-- .... .j $. COMMERCIAL GENERAL LIABILITY CLAIMS MADE F-1 OCCUF GEN'L AGGREGATE LIMIT APPLIES AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY -1 ANY AUTO EXCESSIUMBRELLA LIABILITY OCCUR 71 CLAIMS MADE DEDUCTIBLE ! t`3 2003 RECORDS ND VE SRVCS EPT WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? IT yes, describe under SPECIAL PROVISIONS below A OTHER Professional W1501A08PNPA 9/5/200$ 9/5/2009 Liability DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS OLDER City of Clearwater City Clerk P.O. Box 4748 Clearwater, FL 33758-4748 ACORD 25 (2001/08) IMCl19C ,nnono.. I MED EXP (Anv one oersonl 1 $ 1 GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: _ $ I E.L. EACH ACCIDENT 1 $ 1 r i I,n Per Claim $5,000,00 Aggregate $7,500,00 CANCELLATION 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 Matias Ormaza/NOYOLA © ACORD CORPORATION 1988 Penn I nF 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) INS025 (o1oayma Page 2 of 2