CERTIFICATE OF LIABILITY INSURANCE (125)Client#: 155224 14FIBERLIGHT
DATE (MM/DD/YYYY)
ACORD,� CERTIFICATE OF LIABILITY INSURANCE 5/09/2012
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 CONTACT
NAME:
J. Smith Lanier & Co.-Atlanta PHONE �70 476-1770 F°'X 770 476-3651
11330 Lakefield Drive �A Lo eXr : a,ic, No :
ADDRESS:
Bldg 1, SUIt@ � OO INSURER(S) AFFORDING COVERAGE NAIC #
Duluth, GA 30097 . Phoenix Insurance Company 25623
INSURED
FiberLight, LLC
11700 Great Oaks Way, Suite 100
Alpharetta, GA 30022
COVERAGES
CERTIFICATE NUMBER:
INSURER A .
�NSUReR e: Travelers Property Casualty Co. 25674
�r,suReR c: Travelers Casualty and Surety C 19038
iNSUReR o: Travelers Indemnity Co. of Amer 25666
INSURER E :
REVISlON NUMLER:
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 TypE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP LIMITS
LTR INSR VWD POLICY NUMBER MM/DD MM/DD
A GENERAL LIABILITY H6307B67525APHX12 5/09/2012 05/09/201 EACH OCCURRENCE $1 000 000
X COMMERCIAL GENERAL LIABILIN PREMISES Ea o"cu ° n� $1 OOO OOO
CLAIMS-MADE � OCCUR MED EXP (Any one person) $ � � ���
PERSONALBADVINJURY $�,OOO,OOO
GENERALAGGREGATE $Z�OOO,OOO
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ Z,OOO,OOO
POLICY PR� LOC $
JECT
p AUTOMOBILE LIABILITY BA7B67525Al2TEC 5/09/2012 05/09/201 Ee aBctleDISINGLE LIMIT ,�,000,oOQ
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $
AUTOS Per accident
$
g X UMBRELLA LIAB X occuR HSMCUP7B67525ATIL1 5/09/2012 05/09/201 EACH OCCURRENCE $10 000 000
EXCESS LIAB CLAIMS-MADE AGGREGATE $'I O OOO OOO
DED X RETENTION $� O OOO $
C WORKERS COMPENSATION HAU67667525Al2 5/09/2012 05/09/201 X W RSTLIMIT �TH-
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y� N E.L. EACH ACCIDENT $'I ,OOO,OOO
OFFlCER/MEMBER EXCLUDED? � N / A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $�,���,0�0
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $'I ,OOO,OOO
R����D
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Re: Right of way - Franchise The City of Clearwater is included as additional insured on the above G��al '� '� 2012
Liability Policy ONLY as required by written contract and subject to the limitations and provisions of the
Po�icv� UFIFICB/�01. REC�U�;C)S AI�fG�
l,C�IATNE SRYCS DEPT
Clt of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
a political subdivision of the State of Florida accoR�aNCe WITH THE POLICY PROVISIONS.
112 S. Osceola A
Clearwater, FL 33756 AUTHORIZED REPRESENTATIVE
O 19 8- 010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S1545905/M1545787 LXA