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CERTIFICATE OF LIABILITY INSURANCE (210) A`°R°® CERTIFICATE OF LIABILITY INSURANCE 6/15/2012 Y) 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 Mlchaela Bernier NAME: George Eidson Agency Inc dba Eidson Insurance A/C ONE Ext: (407)849-0333 A/C No: (407)425-5694 P.O. Box 540209 ADDRESS:michaelab @eidsoninsurance.com 2807 Edgewater Dr PRODUCER 00014776 g CUSTOMER ID#: Orlando FL 32854 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER AAmerican Casualty Company 20427 Reiss Environmental, Inc. & INSURER BAuto-Owners Insurance 18988 Reiss Engineering, Inc. INSURERC:Continental Casualty 20443 1016 Spring Villas Pt. INSURER D:Brid efield Employers Ins Co 10701 INSURER E: Winter Springs FL 32708 INSURER F: COVERAGES CERTIFICATE NUMBER:UPDATED 11/12 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 300 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ r A =1 CLAIMS-MADE 1XI OCCUR 2075095657 9/21/2011 9/21/2012 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 ] JECT POLICY X PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 BODILY INJURY(Per person) $ B ALL OWNED AUTOS 4472389700 8/19/2011 8/19/2012 BODILY INJURY(Per accident) $ SCHEDULED AUTOS X PROPERTY DAMAGE $ HIRED AUTOS (Per accident) X NON-OWNED AUTOS PIP-Basic $ 10,000 Medical payments $ 5,000 X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $ 1,000,000 DEDUCTIBLE $ C X RETENTION $ 10,000 2091445161 9/21/2011 9/21/2012 $ D WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS I ER ANY PROPRIETOR/PARTNER/EXECUTIVE F—] E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) 1389600 9/21/2011 9/21/2012 E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Professional Liability- H288355198 7/9/2011 7/9/2012 Liability-Each Claim: $2,000,000 Claims Made Coverage ed. $10,000./Retro: Full Liability-Aggregate $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Alice.Eckman @myClearwater. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Engineering P.O. Box 4748 AUTHORIZED REPRESENTATIVE Clearwater, FL 33758-4748 Michaela Bernier/CLHrk p ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD