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CERTIFICATE OF LIABILITY INSURANCE (2) -11 coRV ;a r CERTIFICATE OF LIABILITY INSURANCE 1 DATE02/2/Y01 DS?2?21 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 1-303-534-4567 CONTACT NAME: INA of Colorado, Inc. PHONE FA_X A/C No : 1550 17th Street E-MAIL ADDRESS: Suite 600 O 80202 INSURERS AFFORDING COVERAGE NAIC # Denver, C INSURER A: PHOENIX INS CO(Travelers Property 25623 INSURED INSURER 6: tw telecom of florida l.p. i INSURER C: tw telecom nc. 3030 N. Rocky Point Drive Nest, Suite 850 INSURER D: INSURER E: Tampa, FL 33607 INSURER F : COVERAGES CERTIFICATE NUMBER: 21007618 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 TH15 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 INSR SUWVD ER POLICY NUMBER (MMIDOffYYYI O EFF MPM/DDY EXP LIMITS A GENERAL LIABILITY HNGLSA15BD4331PHXll 05/01/1 05/01/12 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 1, 000, 000 CLAIMS-MADE F_xIOCCUR MED EXP Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 ?w GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S 2,000,000 POLICV X PRO- X LOC $ AUTOMOBILE LIABILITY COMEaBINED SING LIMIT accident ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS " SCHEDULED AUTOS ?+ ! /? J BODILY INJURY (Per accident) ,..-- $ -..."........._...... HIRED AUTOS NON-OWNED AUTOS ??.,.? i n,.. pROPERTnDAMAGI' .. UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ AND , $ WORKERS COMPENSATION PL ER ' LIABILITY r??? P -, DEPT WC STATU- OTH- TQBy LUM AND EM OY S Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE .. E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N? (Mandatary in NH) N/A E.L. DISEASE - EA EMPLOYE S If yyes describe under DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) The Ciity of Clearwater, a political subdivision of the State of Florida are included as Additional Insureds on the General Liability Policy if required by written contract or agreement subject to the policy terms and conditions. CFRTIFIL'ATF Mffl IIFR CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater City Hall, 3rd Floor AUTHORIZED REPRESENTATIVE 112 Osceola Avenue / f Clearwater , FL 33756 (f ?! USA ACORD 25 (2010/05) SDZM 21007618 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD a IMA of Colorado, Inc. 1550 17th Street Suite 600 Denver, CO 80202 USA City of Clearwater Clearwater City Hall, 3rd Floor 112 S. Osceola Avenue Clearwater, M 33756 USA a:2e4:729 EBIX BPO If you have questions regarding the content of this document, please contact the Producer/Agent listed on the certificate of insurance. cc: The data included in this notice and In the attached document Is confidential to Ebix BPO and the party responsible for bringing you this information. a!a Certificate Delivery by CertificatesNow - www.ConfirmNet.com - 877.669.8600 . ,. . tw telecom inc. POLICY NUMBER: HNGLSA158D4331PHX11 ISSUE DATE: 05-01-11 Effective: 05/01/11 to 05101112 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY -- NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice of Cancellation: 30 Any person or organization to whom you have agreed in a written contract -- - ORGANIZATION: of hi's policy V-141 15-e given; bit-onlyil`-'- _Y.- __. ...-- - ---- ----- -- .---..--- - PERSON QR t You send us a written request to .rovide such notice, including that notice of cancellation p g the name and address of such person or organization, after the first Named Insured shown in the Declarations receives notice from us of the cancellation of this policy; and 2. We receive such written request at least 14 days before the beginning of the applicable number of ADDRESS: days shown in this Schedule. The address for that person or organization included in such written request from you to us PROVISIONS: If we cancel this policy for any statutorily permitted reason other than nonpayment of premium, and a number of days is shown for cancellation in the schedule above, we will mail notice of cancellation to the person or organization shown in the schedule ILT4050311 above. We will mail such notice to the address shown in the schedule above at least the number of days shown for cancellation in the schedule above before the effective date of cancellation. ® 2011 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 3:4