CERTIFICATE OF LIABILITY INSURANCE (3)Rece►ved
MAV 0 4 2�12
AIC�RD� � �. . . DATE (MM/DDIYYW)
`� � CERTIFICATE���OF LIABILITY IN �� OffIC@ �. 4/30/20�12
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(i,es) 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 � � � . CONTACT C G � �
. . . NAME . . ... .
Stahl & Associates Insurance� =IIC. PHONE (']2']� 391-9']91 q/C No: (�Z7)393-5623
110 Carillon Parkway
.. � � � � � INSURER S AFFORDING COVER4GE � � ' NAIC #
St. Petersburg FL 33716 iNSUrtErtn:Amerisure Mutual Ins Co
INSURED �� � ... � INSURERB:�Er1S11TE Insurance �Co �
JMC Development CorP . iNSUR� c: , ,
2201 4th St N, Suite 200 iNSUReao: '
. . .. � . . � INSURER E : . . �. .. �
St Petersbur FL 33?04 ' iNSUReRF:
COVERAGES CERTIFICATE NUMBER:CL1243014624 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 INSUR,4NCE 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 � � TVPE OF INSURANCE ADDL SUBR �� POLICY EFF POLICY EXP �' � L�MITS �� �
LTR � � � POLICY NUMBER MMIDDIYW MMIDD/YYY ���
GENERAL LIABILITY . � � . � EACH OCCURRENCE. � � S � � �
� COMMERCIAL GENERAL GABILITY '� �. � AMAG TO NT D �. S � �
� � � � PREMISES Ea occurrence � �'
� �CLAIMSMADE � OCCUR � � � � .. MED EXP (Any one person) � S � �
' � � � � � � � � �� PERSONAL 8 ADV INJURY S � � �
� � � � � �� � � � � GENERAL AGGREGATE S
GEN'L AGGREGATE LIMIT APPLIES PER: � .. . . PRODUCTS - COMP/OP AGG 5 � �
POLICY. � PRO- LOC . . . S .
AUTOMOBIIE.LIABILITY .. � . � . COMBINED SINGLE LIMIT
Ea accident S 1 000 000
A � ANY AUTO .. � BODILY INJURY (Per person) S �
�ALLOWNED SCHEDULED 027550 . ��. /1/2012. /1/2013 �
AUTOS � � �AUTOS � � . � � . BODILYINJURY(Peraccident). S .
x . HIRED flUTaS' � X NON-OWNED . . � � . PROPERTY DAMAGE S.. �. �. � � �
AUTOS � � � Per accident � �
�. . �. .. .. ... . S .. . .
� UMBRELLALIAB OCCUR �� � � EACH OCCURRENCE S��
. � �� EXCESS LIAB CLAIMSMADE �. � � � , . � � � � AGGREGATE � � � S �
�� � DED� REfENTION$ ' � � � � � � � � '�5 � ��
$ WORKERS COMPENSATIOM � � � � � � � � X WC STATU- OTH- . .
�AND EMPLOYERS' LIABILITY �.
ANYPROPRIEfOR/PARTNER/IXECUTIVE Y/N � ��E.L.EACHACCIDENT S. SOO OOO
OFFICERlMEMBER EXCLUDED? � � N�p' C1385656 /1/2012 /1/2013
.�. (Mandatory in NH) . . E.L. DISEASE - EA EMPLOYE S b�� 00�
� If yes descri6e. under
DESCRIPTION OF OPERATIONS belan � � � � � � � E.L. DISEASE = POLICYLIMIT S � SO�O OOO
DESCRIPTION OF OPERATIONS / LOCA710NS ( VENICLE3 (Attach ACORD 107, Atltlitional Remarks Schedule, if more space is required) � � .. . �
Re: Marquesas, LI,C.
CERTIFICATE HOLDER CANCELLATION
' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
'' ' THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
'C1t.17 Of Cle8r4JdtEr ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: City Manager
� PO BOX 4%�QH � � AUTHORIZEDREPRESENTATIVE � � �
Clearwater, FL 33758-4748 '
Kelly Petzold/BAILEY ' 1 ""c"�.� �' P�'�"-
ACORD 25 (2010/05) ' O 1988-2010 ACORD CORPORATION. All rights reserved.
INS025 �zo�oos� o� The ACORD name and logo are registered marks of ACORD