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CERTIFICATE OF LIABILITY INSURANCE (163)OP ID: AJK1 c 3R° CERTIFICATE OF LIABILITY INSURANCE 0 DAT3121D/YYYY) 03/21 /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 endorsement(s). PRODUCER 727-522-7777 NCONTACT AME: Wallace Welch & Willingham Inc 727-521-2902 PHONE A!C Nc Ext : A/C No - 300 First Avenue South, 5th Fl E-MAIL ADDRESS: _ P.O. Box 33020 FL 33733 St P t b PRODUCER CUM&F-1 CUSTOMER ID 0: urg, . e ers INSURERS AFFORDING COVERAGE _NAIC # INSURED Cumbey & Fair, Inc. INSURER A: Nat'l Fire Ins Co of Hartford 01505 2463 Enterprise Rd. INSURER B: Architects & En ineers Ins Co 44148 Clearwater, FL 33763 INSURER C: Transportation Ins. Co. 20494 INSURER D: BusinessFirst Ins. Co. INSURER E : INSURER F : COVFRAnFS 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. INSR LTR TYPE OF INSURANCE?T A L S B POLICY NUMBER MM DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,0 0 0,00 A X COMMERCIAL GENERAL LIABILITY 2086949437 03/16/11 03/16112 PREMISES (Ea occurrence) ES Ea _ _ $ 300,00( CLAIMS-MADE u OCCUR MED EXP (Any one person) $ 10,00 u PERSONAL & ADV INJURY $ 1,000,000 _ Y?mmT GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 POLICY WX PRO LOC Emp Ben. $ 1,000,00 AUT OMOBILE LIABILITY [? ECEW E L 116/11 03116/12 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 A X ANY AUTO 2088208783{)? ^ _T BODILY INJURY (Per person) $ ALL OWNED AUTOS 1 BODILY INJURY (Per accident) $ SCHEDULED AUTOS MAR 2 r 11 PROPERTY DAMAGE HIRED AUTOS (Peraccident) $ NON-OWNED AUTOS - IC1 /r 1 RECOR DS ANO $ ? rF Ll/"10• RV?emi $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 EXCESS LIAB CLAIMS-MADE 03!16111 03!16/12 AGGREGATE $ 1,000,00 C 2086949471 DEDUCTIBLE $ TENTION 10,000 _ ._ - -- -.. - - -- - -- $ WORKERS COMPENSATION X WC STAT - OTH- AND EMPLOYERS' LIABILITY T Y D ANY PROPRIETOR/PARTNER/EXECUTIVE N / A 052024651 03/16/11 03116112 E.L. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? 1 000 00 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE , , $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00 B Professional Liab AEICPG11 03116/11 03/16/12 Ea Claim 1,000,00 CLAIMS MADE Aggregate 1,000900 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Certificate holder is additional insured on a primary and noncontributory basis with respect to General Liability if required by written contract per form G17957G and certificate holder is additional insured with respect to auto liability and Excess policy per coverage forms, waiver of subrogation CFRTIFICATF MOI nFR CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS. City Clert P.O. Box 4748 AUTHORIZED REPRESENTATIVE Clearwater, FL 33758-4748 ^ *0/ ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD IHOLDER CODE CUM&F^1 PAGE 2 INSURED'S NAME Cumbey & Fair, Inc. OP ID: AJK1 DATE 03121/11 to to General Liability & Auto Liability if required by written