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CERTIFICATE OF LIABILITY INSURANCE (198)�.�-.� ADVAN04 OP ID: CA '`�`�..°RO� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 03/14/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATNELY OR NEGATNELY 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 REPRESENTATNE 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(sl. PRODUCER Hockman Insurance Agency, Inc. 3438 Coiwell Avenue Tampa, FL 33614 Hockman Insurance Agency, Inc. INSURED Advanced Systems Engineering, Inc 13555 Automobile Blvd., #330 Clearwater, FL 33762 813-636-4000 NAME:y� C stal A ers 813-281-1086 ,P,,",c"N .Ex�,:813-865-1188 INSURER B : INSURER C : INSURER E : aninsurance.com Everest National Insurance Co 813-281-1086 NAIC # 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 7ypE OF INSURANCE ADDL SUBR pOLICY NUMBER MM/DD/YYYY MM/DDYYYYY LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ DAMA ET R N ED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE � OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PR� LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED MAR 1.9 20 2 BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR �e�y�i /��/C C@�/ D� EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE v��"�` J,`• AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY �, � N Y IMIT ANY PROPRIETOR/PARTNER/EXECUTIVE f�l E.L. EACH ACCIDENT $ � CfF;CER;!-7EN9ER FY.CLUDEpo L_� N/ A (Mandatory in NH) E.L. DISeASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Professional 79AE001404-121 03/10/12 03/10/13 Per Claim 2,000,00 Liability Ann Agg 2,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schetlule, if more space is required) Professional Liability coverage is written on a claims made and reported basis. City Of Clearwater City Clerk PO Box 4748 Clearwater, FL 33758-4748 ACORD 25 (2010/05) CITYOFC 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 / w''� `V'�..s�/ OO 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD