CERTIFICATE OF LIABILITY INSURANCE (127)Client#: 137132
14ENERCONSER
ACORD,M CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
__ _ 06/28/2012
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 C NTA T
NAME:
J. Smith Lanier & Co.-Atlanta PHONE 770 476-1770 F'0'" 770 476-3651
A/C, No Ext : AIC, No :
11330 Lakefield Drive E-MAIL
ADDRESS:
Bldg 1, Suite 100 INSURER(S)AFFORDINGCOVERAGE NAIC#
Duluth, GA 30097 iNSURERA: Chartis Specialty Insurance Co. 26883
INSURED iNSURERe: Hartford Fire Insurance Co. 19682
Enercon Services, Inc. iNSUReR c: Markel Insurance Company 38970
500 Town Park Lane Ste. 275
INSURER D :
Kennesaw,GA 30144
INSURER E :
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 ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD MM/DD/YYYY LIMITS
A GENERALLIABILITY 24204154 7/01/2012 07/01/201 EACHOCCURRENCE $��00�����
X COMMERCIAL GENERAL LIABILITY PREMISES EaEoNccTurren� $3OO OOO
CLAIMS-MADE � OCCUR MED EXP (Any one person) $ZrJ����
PERSONAL & ADV INJURY $ � �OOO�OOO
GENERALAGGREGATE $Z�OOO�OOO
GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $Z�OOO�OOO
X POLICY PR� LOC $
JECT
B AUTOMOBILELIABILITY 20UENJW90 1/2012 07/01/201 COMBINEDSINGLELIMIT �,OOO,OOO
Ea accident $
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED ��B O � � ��
BODILY INJURY (Per accident) $
AUTOS AUTOS
X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $
AUTOS Per accidenl
i $
A UMBRELLA LIAB X OCCUR 2420439 07/01/201 EACH OCCURRENCE $11 000 000
X EXCESS LIAB CLAIMS-MADE ����� �� �� AGGREGATE $� � OOO OOO
DED RETENTION $ $
B WORKERSCOMPENSATION 20WEAE9351 7/01/2012 07/01/201 X WCSTATU- OTH-
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y� N E.L. EACH ACCIDENT $� OOO OOO
OFFICER/MEMBER EXCLUDED7 ❑ 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 $� �OOO�OOO
C Professional 12EOM00008 4/18/2012 04/18/201 $5,000,000 each claim
C Professional 12EOM00008 4/18/2012 04/18/201 $5,000,000 Agg.
A Pollution Liab 24204154 7/01/2012 07/01/201 $1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
Certificate Holder is named as additional insured as per written contract, subject to the provisions and
limitations of the policy. Waiver of subrogation applies per written contract, liability policies are
written on primary basis. Separation of insured applies
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Attn: City Clerk ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 4748
Clearwater, FL 33758 AUTHORIZED REPRESENTATIVE
O 79 8- 010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) 1 Of 1 The ACORD name and logo are registered marks of ACORD
#S1596765/M1596633 TZP