CERTIFICATE OF LIABILITY INSURANCE (128)� � DATE (MNVDD/YYY1�
-oR° CERTIFICATE OF LIABILITY INSURANCE o6�2ai2o�z
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
Marsh USA, Inc.
3031 N. Rceky Parrt Drive West, Suite 700
Tampa, FL 33607
342881-FL-WC-12-13
INSURED
DecisionHR, Inc.
PO Box 33024
St. Petersburg, FL 33733-8024
5061
PHONE
(NC. No. ExtF:
E-MAIL
ADDRESS:
INSURER(S) A
iNSUReR p: Illinois National Ins Co
INSURER B :
INSURER C :
INSURER D :
INSURER E :
NAIC #t
COVERAGES CERTIFICATE NUMBER: A7L-oo3o98676-Ot REVISION NUMBER: t
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 UBR POLICY EFF POLICY EXP ��M��
LTR POLICY NUMBER MIWDDMfYY MM/DD/YYYY
GENERAL LIABILITV EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISES Ea occurrence $
CLAIMS-MADE � OCCUR MED EXP (M one person) $
RECEII/E PERSONAL 8 ADV INJURY $
GENERALAGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/0P AGG $
POLICY PR� LOC $
AUTOMO&LE LIABILITY COMBINED SINGLE LIMIT
ce accidani
ANY AUTO OFFICIAI. RECARD AI*1� BODILY INJURY (Per person) $
AUTOS NED AUTOSULED
���� �� D�� BODILY INJURY (Per accident) $
HIRED AUTOS NON-OWNED PROPERTY DAMAGE $
AUTOS Per accident
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $
q WORKERS COMPENSATION 037010557 06101(2012 06�01/2013 X WC STATU- OTH-
AND EMPIOYERS' LIABILITY Y� N 1,000,000
ANY PROPHIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? � N � A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 1,000,000
If yes, describe untler 1,000,000
DESCF;IPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTON OF OPERATIONS / LOCATIONS / VEHICLES (Attech ACORD 101, Additlonal Remarks Schedule, if mora spaca is required)
Coverage is provided for only those employees leased to but not subcontractws of BillerReinhart Structural Group, Inc.
City of Clearwater
Attention: City Clerk
P.O. Box 4748
Clearwater,FL 33758-4748
ACORD 25 (2010/05)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICV PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA Ina
Kim Arvanitis ,Y��—�-�"S'�.->�+��
� 198&2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
0004892 SP 0211 -001-P04894-I
City of Clearwater
Attention: City Clerk
P.O. Box 4748
Clearwater, FL 33758-4748 �