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CERTIFICATE OF LIABILITY INSURANCE (102)AcoR1O0 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1??• 1/4/2011 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 Commercial Lines- (813) 639-3000 CONTACT NAME: ChrYstal Hatcher W ll F I USA S i I Erna Ext : 813.639.3019 ac No): 813_639.7198 e argo , nsurance s erv ces nc. ADDRESS: chrystal.hatcher@wellsfargo.com 2502 N. Rocky Point Drive, Suite 400 PRODUCER 11762 CUSTOMER ID Tampa, FL 33607 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Hartford Fire Insurance Co. 19682 Image One Corp dba INSURER S 6206 Benjamin Rd #301 INSURER C : INSURER D : Tam a FL 33634 INSURER E : p INSURER F : COVERAGES CFRTI :ICATF NIIMRFR• LL4414U RFVIRICIN NIIMRFR- SL-L- halow 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 6b U R POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY 21SBALI1614 1/1/2011 1!1/2012 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE RENTED PREMISES S (Ea occurrence) $ 300,000 CLAIMS-MADE F)? OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN ER AL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: _ _ PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY 71 PRO- LOC $ A AUT OMOBILE LIABILITY 21UECLI4905 11 1/1/2012 COMBINED SINGLE LIMIT $ 1,000,000 ECEI ? (Ea accident) X ANY AUTO R -' BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ X SCHEDULED AUTOS HIRED AUTOS JAN O 011 PROPERTY DAMAGE (Per accident) $ X NON-OWNED AUTOS w $ L-*FICIAL RE CC AN $ -- A UMBRELLA LIAB X OCCUR 21SBAL116 1/1/2012 EACH OCCURRENCE $ 3,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE S 3,000,000 a DEDUCTIBLE _ X RETENTION $ 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 21WECDU9811 1/1/2011 1/1/2012 X AWC STUAMTIU OTH- YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ? N / A E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER IS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY L;tK I II-IUA I t HVLUtK CANCELLATION CITY OF CLEARWATER ATTN: CITY CLERK P O BOX 4748 CLEARWATER FL 33758 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved, ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD