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CERTIFICATE OF LIABILITY INSURANCE (115)ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDMYY) F TM a/31/2009 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 P Box 2456 C HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR . . S i 660 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. u te Clearwater FL 33757-2456 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA! Hart ford Fire Insurance Co. - 19682 Kisinger Campo & Assoc. Corp. KCCS Inc INSURERB:Hartford Casualt-y___Insurance C 9424 , 201 N Frankli n Street Ste 400 INSURERC Continental Casualty Co. 20443 . , Tampa FL 33602 INSURERD: I NSURER 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 LTR DD' INSRD POLICY NUMBER POLICY EFFECTIVE DATE MM D POLICY EXPIRATION DATE MM DD LIMITS A X GENERAL LIABILITY 21UUNAG7547 9/1/2009 9/1/2010 EACH OCCURRENCE $ 1 000, 000 X COMMERCIAL GENERAL LIABILITY PREMISES Eaoccurence $10 0 000 _ CLAIMS MADE L OCCUR MED EXP (Any one person) $ 5 000 PERSONAL &ADV INJURY $ 1 O Q O 00 0 GENERAL AGGREGATE $2,000,000 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS -COMPIOPAGG - $2,000,000 X POLICY PRO- LOC A X AUTOMOBILE LIABILITY 21=AG7 54 7 9/l/2009 9/ 1/ 2 010 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $1,00(),000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULEDAUTOS (Per person) X HIREDAUTOS BODILYINJURY NON-OWNEDAUTOS (Peraccident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTOONLY-EAACCIDENT $ ANY AUTO OTHERTHAN EAACC $ AUTO ONLY: AGG $ B X EXCESSIUMBRELLA LIABILITY 21 XHUAG 7 6 0 7 9/l/2009 9/ 1/ 2 010 EACH OCCURRENCE $ 3 0 0 0 000 X OCCUR CLAIMS MADE AGGREGATE $ 3 0 0 0 000 DEDUCTIBLE $ }{ RETENTION $10 000 $ A WORKERS COMPENSATION AND 21WENW1033 10/3/2009 10/3/2010 ORYLIMTS OER EMPLOYERS' LIABILITY __ RTNER/EX E C E.L. EACH ACCIDENT - $500,000 ANY PROPRIETOR/PA E UTIV OFFICERIMEMBEREXCLUDED? ------ E.L. DISEASE - EA EMPLOYEE $50(),00() If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $500,000 C OTHER EH288295813 11/2/2008 11/2/2009 Per Claim 2, 000, 000 Professional Liability Aggregate 5,000,000 Claims Made Deductible 200,000 DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES I 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. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER City of Clearwater WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN NOTICE TO THE Attn: City Clerk CERTIFICATE HOLDER NAMED TC THE LEFT, BUT FAILURE TO DO SO P. 0. Box 4748 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON Clearwater FL 33758-4748 THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE J`ti ? yG(,?fL/L? ACORD 25 (2001108) ©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 25 (2001108)