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CERTIFICATE OF LIABILITY INSURANCE (162)OP ID: JT .4CaR0° ? CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 03/10/11 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 endorsements . PRODUCER 813-636-4000 NAME: Hockman Insurance Agency, Inc. 813 281 1086 PHONE FAX - - 3438 Colwell Avenue ac No Ext : A/c No : Tampa, FL 33614 E-MAIL ADDRESS: Ron Hockman PRODUCER CUSTOMER ID #: ADVAN04 INSURERS AFFORDING COVERAGE NAIC # INSURED Advanced Systems INSURER A : Camden Fire Insurance Assoc. Engineering, Inc. INSURER B : 13555 Automobile Blvd., #330 INSURER C : Clearwater, FL 33762 INSURER D INSURER E : INSURER F : 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 S B WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ - CLAIMS-MADE F IOCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ _ EN1 AGGREGATE LIMIT APPLIES PER: G PRODUCTS - COMP/OP A GG $ _ Y POLICY Pirci RO LOC _ $ AUT OMOBILE LIABILITY ry ps ? ??? SINGLE LIMIT COMBINE d pt E $ ) e ( a ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS r- BODILY INJURY (Per accident) S ^ ^ SCHEDULED AUTOS ?- 2011 PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS v` ` y •?"?nL 1t? ?, ; $ r 11J'?pi UMBRELLA LIAB OICIR EACH OCCURRENCE $ EXCESS LIAB H CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ _ y.. -RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE ? NIA E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Professional DPL-0600-11 03/10/11 03/10/12 Per Claim 2,000,00 Liability Ann Agg 2,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Professional Liability coverage is written on a claims made and reported basis. CERTIFICATE HOLDER CANCELLATION CITYOFC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Clearwater THE EXPIRATION DATE, THEREOF, NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 4748 Clearwater, FL 33758-4748 AUTHORIZED REPRESENTATIVE "" ?`1 ° Ron Hockman_ a.••• ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 26 (2009/09) The ACORD name and logo are registered marks of ACORD Clipnf#- A955 ADVASYS3 ACORDTM CERTIFICATE OF LIABILITY INSURANCE F DATE (MMDDIY?) 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 NAME: ISU Suncoast Insurance Assoc PHONE Ext: 813 289.5200 F0X arc, No : 813 289-4561 P.O. Box 22668 E-MAIL ADDRESS: Tampa, FL 33622-2668 CUSTOMER ID #: 813 289-5200 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Phoenix Insurance Company 25623 INSURER A: Advanced Systems Engineering, Inc. INSURER B, Travelers Indemnity Company 25658 PO Box 1915 INSURER C : Travelers Casualty 8r Surety Co 19038 Oldsmar, FL 34677 INSURER D : INSURER E : INSURER F : -COVERAGES- -- . - - CERTIFICATE NUMBER: . . REVISION NUMBER:... . 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. SR LT TYPE OF INSURANCE DL INSR R D POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY 6606851 L26A 10/02/2010 10/02/2011 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $1,000 000 CLAIMS-MADE FRIOCCUR MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS - COMP/OP AGG $2,000,000 POLICY X PRO LOC $ B AUT OMOBILE LIABILITY BA4883 ) 08117/2010 0811712011 COMBINED SINGLE LIMIT $ ?.F.' (Ea accident) 1,000,000 ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS / I A L 201 BODILY INJURY Per accident ( ) $ X SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Peraccident) $ X NON-OWNED AUTOS RECORDS r $ /? ?lM :.,?.7IStA11W. i.F r:r M Y` S B X UMBRELLA LIAB OCCUR CUP6849Y191 8/17/2010 08117/2011 EACH OCCURRENCE s510001000 EXCESS LIAB CLAIMS-MADE AGGREGATE _ $5,000,000 DEDUCTIBLE . $ ?....._`.??._.._ _ M .. .. r -- -- _. C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY UB684SY201 08117/2010 0811712011 X WC STATU- OTH- ANY PROPRIETORIPARTNER/EXECUTIVEY/" N/A E.L. EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Certificate holder is listed as an additional Insured With respects to General Liability, Auto Liability and Excess Liability policies on a [(See Attached Descriptions) GANULLLA I IUN City of Clearwater Attn: City Clerk PO Box 4748 Clearwater, FL 33758-4748 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 OLD '0)L O&-o[-. A06-1 ACORD 25 (2009/09) 1 of 2 #S306137/M306133 01988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD KEB