CERTIFICATE OF LIABILITY INSURANCE (216)'4`,°�O� C E RT I F I CAT E O F LIA 61 LITY I N S U RA N C E DATE (MM/DD/YYYY)
6/28/2012
PRODUCER (201) 262-1200 FAX: (201) 262-7810 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Fenner &$sler ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
467 Kinderkamack Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. O. Box 60
Oradell NJ 07649-0060 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURERA: Ct18Y'tHr Oak Fire II18L1=SI1CH 25615
Biller Rainhart Structural Group, Inc. iNSUReRS:�verest National Insuranca loi2o
4014 Gunn Highway, Suite 248 INSURERC:
INSURER D:
Tampa FL 33618 INSURERE:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOIIMTHSTAN DING
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR DD' POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERALLIABILITY EACHOCCURRENCE $ 2,000,000
X COMMERCIAL GENERAL LIABILIN PR M SES Ea occur ence $ 1, OOO , OOO
A CLAIMSMAOE � OCCUR 680-8783L610-COF-12 3�Z�Z�li 3/1/2013 MEDEXP(Anyoneperson) $ 1���0�
PERSONAL & ADV INJURY $ 2� OOO , OOO
GENERAL AGGREGATE $ 4� O O O, O O O
GEN'L AGGREGATE LIMR APPLIES PER: PRODUCTS - COMP/OP AGG $ 4� OO O i OO O
X POLICY PR� LOC
AUTOMOBILE LIA8ILITY
COM8INED SINGLE LIMIT $ 1; 000, OOO
ANY AUTO
(Ea accident)
li ALLONMEDAUTOS 680-8783L610-COF-12 3/1/2012 3/1/2013 gODILYINJURY
SCHEDULED AUTOS (Per person) $
X HIRED AUTOS ����� � BODILY INJURY $
X NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO EA ACC $
E3F f�.lAl RECOR S�►N� AUTO ONLYN AGG $
EXCESS / UMBRELLA IIABILITY •`% DG� EACH OCCURRENCE $
OCCUR � CLAIMS MADE AGGREGATE $
$
DEDUCTIBLE $
RETENTION S $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE � E.l. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) E.l. DISEASE - EA EMPLOYE $
If yes, describe under
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $
B OTHERprOfe8810A81 79AE000318-121 3�1�2012 3/1/2013 Per Claim Limit l, 0��� �0�
Liability Annual Aggregate 1, 000, 000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Additional Insured - Certi£icate Holder as respects general liability where required by written contract.
CERTIFICATE
City of Clearwater
Attn: City Clerk
PO Box 4748
Clearwater, FL 33756-4748
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BECANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 � DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ITimothy 8sler/D88BI8 � ���
ACORD 25 (2009/01) O 1988-2009 ACORD CORPORATION. All rights reserved.
iNS025 �zoosoi�.oi The ACORD name and logo are registered marks of ACORD
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized
representative or producer, and the certificate holder, nor does it affirmatively or negatively amend,
extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2009/01)
INS025 �zooso>>.oi