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CERTIFICATE OF LIABILITY INSURANCE (180) OP ID: AJK1 CERTIFICATE OF LIABILITY INSURANCE DATE 03 1/( 211!11 111 2 Y} THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS :ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES I, 3ELOW. 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 MA ME:ONTACT Wallace Welch&Willingham Inc fMA i FAX 300 First Avenue South, 5th FI 727-521-2902 rC'U. Exf: P.O. Box 33020 ADDRESS: _ aR6otic�ri----------- St. Petersburg, FL 33733 CUSTOMER 109.CUM&F-1 1NSURER(S)AFFORDING COVERAGE _ NAICA INSURED Cumbey& Fair, Inc INSURER A:Nat'l Fire Ins Co of Hartford W 01505 2463 Enterprise Rd. INSURERB:Architects&Engineers Ins Go 144148 Clearwater, FL 33763 INSURER C:Transportation Ins. Co. 20494 INSURER D:BusinessFirst Ins. Co. 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, INSR ---.._._.,- ----.___, ---pOLICY_BH Po LTC EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER JMMvDDtYYYYJ f1AMMD[YYY'Y) LIMITS GENERAL LIABILITY EACH OCCURRENCE _ _S 1,000,000 • X COMMERCIAL GENERAL UAWLIfY 086949437 03116111 03/16112 DMAGETO REENT rreric� $ 300,000 CLAIMS-MADE �OCCUR MM"P(Any one person) $ 10,000 PERSONAL&AW INJURY $ 1,000,000 ^ GENERAL AGGREGATE 5 2,000,000 GEN.L AGGREGATE LIMIT APPLIES PER- PRODUCTS-COMPIOPAGG 5 2,000,000 POLICY X PRO- LOC Emp lien. S 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLELIMIT $ 1,000,000 (Ea accident) • X ANY AUTO 088208783 03116/11 03/16/12 BODILY INJURY leer person) $ _ ALL OVvNED AUTOS BODILY INJURY(Per accident) $ SCHETHILEO AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) 5 NON-OWNEDAUTOS 5 UMBRELLA LIAB X OCCUR EACH OCCURRENCE—_.— 1,000,000 C 086949471 03116111 03116112 FXCESS _LIAB CLAUAS-MADE AGGREGATE ----.�" 5 — 1,000,000 _ _ DEDUCTIBLE 5 X RETENTION S 10,000 WORKERS COMPENSATION Vtr–STATU- OTH- AND EMPLOYERS LIABILITY X TORY LIMITS ER D ANY PROPRIETORIPARTNER,EXECUTIVEa NrA 052024651 03116111 03/16112 £.L EACH ACCIDENT 5 1,000,000 FFI OCERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYFd S 1,000,000 IF yes,describe under OESCRiPTIONOFOP€RATlONSbelow E.LDISEASE•POLICY LIMIT 1$ 1,000,000 B Professional Liab �EICPG11 03/16111 03/16/12 Ea Claim 1,090,0 FLAIMS MADE Aggregate 1,000,0 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES(Attach ACORO 101,Additional Remo*s Schedule,If more space Is required) Certificate holder Is additional insured on a primary and noncontributory basis with respect to General Liabilittyy if required by written contract per form G17957G and certificate holderls additional Insured with respect to auto liability and Excess policy per coverage forms,waiver of subrogation CERTIFICATE HOLDER 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. City Clert �.. P.O. Box 4748 Clearwater,FL 33758-4748 AUTHORIZED REPRESENTATIVE ©1968-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD NOTEPAD. HOLDER CODEm CUM&F-1 PAGE INSURED'S NAME Cumbey& Fair, Inc. OP 11);AJK1 DATE 03/21111 applies to to General Liability&Auto Liability if required by written cohtract. t { t