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CERTIFICATE OF LIABILITY INSURANCE AC?Rl? ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDlYVYY) 9130/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER Beecher Carlson Insurance Services CONTACT NAME: ATL Judith Boich w 2002 Summit Boulevard, Suite 900 PHONE AIC o x<),. q78-539-4827 FAX A/c No: 678-539-4890 Atlanta, GA 30319 MAIL ADDRESS: jboich -beechercarls4.Li car m INSURER(S) AFFORDING COVERAGE NAIC # www.beechercarison.com _ -INSURER A: Ace American Insurance Company _..__ __2266'7 INSURED Coca-Cola Refreshments USA, Inc. INSURER B: National Union Fire Insurance CoMpAny 19445 f/k/a Coca-Cola Enterprises Inc. INSURER c : New Hampsnire_)nsurance Com an 23841 DBA Florida Coca-Cola Bottling Co. INSURER D : Indemnity Insurance Company of North America 43575 -- 2950 Gandy Bridge Blvd. - ?- FL 33702 Petersbur St INSURER E: _ • ,,,-_.--_ . g INSURER F : _ _ f:nvrrZ4C;rS CERTIFICATE NUMBER: 8421279 REViSiON NUiriSER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL UB M POLICY NUMBER POLICY EFF MM/DDlYYYY POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY HDOG25521468 10/2/2010 5/1/2011 EACH OCCURRENCE $ 2,000,000 7 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence s 50,000 CLAIMS-MADE D OCCUR MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY s 1,000,000 u GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 5,000,000 POLICY PRO LOG B AUT OMOBILE LIABILITY 3976614 AOS) ( 10/2/2010 5!1/2011 COMBINED SINGLE LIMIT Ea accident) ??- $ _ ?u 000 C Y/ ANY AUTO 3976615 (MA) 10!212010 5/1/2011 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ B R NON-OWNED 3976616(VA) 10/2/2010 5/1/2011 PROPERTYDAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ u EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ $ D WORKERS COMPENSATION ' WLR C46140308 (AOS) 10/2/2010 5/1/2011 TORYL TU- O?RH AND EMPLOYERS LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L. EACH ACCIDENT $ 1 000 ,000 A OFFICER/MEMBEREXCLUDED? L SCF C4614031A (WI) 10/2/2010 5/1/2011 (Mandatory In NH) E.L. DISEASE - EA EIviPLG'r EE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 000 000 A Excess WC (AZ, CA, LA, MD, NV, OR WCU C46140321 10/212010 5/1/2011 Statutory Excess of $1 MM each accident RI, WA, MA) for listed states except MA-Statutory A Excess WC GA & OH WCU 046140333 10/2/2010 5/1/2011 Excess of 0500,000 for each accident DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) RECEIVED CERTIFICATE HOLDER CANCELLATION AND CORDS A SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater OFFICIAL RE e?? err ? DEF THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN rn? Attn: Mark Goheen LEGISIAWE SRVCS ACCORDANCE WITH THE POLICY PROVISIONS. 4748 P O B ox . . Clearwater FL 33756 AUTHORIZED REPRESENTATIVE ATL Robert W. Hessel ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CERT NO.: 8421279 (ATL) Judith Botch 9/30/2010 11:36:13 AM Page 1 of 1