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CERTIFICATE OF LIABILITY INSURANCE (4)R? CERTIFICATE OF LIABILITY INSURANCE WIN I 1 DATE(MMIDDIYYYY) F N 01/11/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Carlisle Fields & Company, LLC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P. O. Box 1027 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Clearwater FL 33758-7910 Phone:727-797-0441 Fax:727-725-3663 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Capitol Specialty Inc. Corp, INSURER B: Zenith Insurance Company Winnin gInning Inc Randy Holland INSURER C. PO Box 15953 Clearwater FL 33766 INSURER D INSURER E: COVERAGES THE POLICIES OF INSURANCE LI-,TED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM ?-I -?-1 LJTION OF ANY r--- TPA- - OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE I--LIED -1 MAY PERTAIN, THE INS. RAIL-.F:.FF F'DED F THE _' ?I_l.-IF , DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CO FITI I.=..'G _?. iCH POLICIES. AGGREGATE LIMII? -HOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDNM) POLIC:YI=XHKA11QN DATE (MMIDDNM) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X X COMMERCIAL GENERAL LIABILITY P2GL10792102 01/01/10 01/01/11 PREMISES (Ea occurence) $100000 CLAIMS MADE X1 OCCUR MED EXP (Any one person) $ 5000 PERSONAL &ADV INJURY $1000000 GENERAL AGGREGATE $ 2000000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOPAGO $ 2000000 X POLICY PRO LOG PRO AUT OMOBILE 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 ac-ilmt) $ F'= _,PERTY DAMAGE (F'..? , i.: nt) $ GAR AGE LIABILITY AUTO _I.LY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGO $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ 7H CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ - $ WORKERS COMPENSATION - 77 AND EMPLOYERS' LIABILITY TCR.1 LIMITS ER B YIN ANY PROPRIETORIPARTNERIE` I : UTIVE Z067810705 11/05/09 11/05/10 E_L. E' HACCIDENT $ 100000 OFFI CERIMEMBER EXCLUDED (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $100000 If yes, describe under SPECIAL PROVISIONS below EL DISEASE- POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS City of Clearwater is listed as Additional Insured with respects to General Liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITYO 05 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 Cit of Clearwater REPRESENTATIVES. y 100 S. Myrtle Ave. AUTHORIZED REPRE TATIVE Clearwater FL 33758 \-# III A ACORD 25 (2009101) ©1986f2I§0QAtE(0I% CO rved. The ACORD name and logo are registered marks of ACORD 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 This Certificate of Insurance 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 (2009101)