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CERTIFICATE OF LIABILITY INSURANCE (2) CLEAR11 OP ID: KB ,acoRO"" CERTIFICATE OF LIABILITY INSURANCE DAT 01/18D/YYYY) 01/18/13 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). CONTACT PRODUCER 727-784-8554 NAME: Stahl Ross&Associates Inc. HOE 3939 Tampa Road 727-789-2823 A/CNNo EXt: FAX No): Oldsmar,FL 34677 E-MAIL Michael Pagano ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:National Trust Ins. Co. INSURED Clearwater Golf Club LLC INSURERB:Zenith Insurance Company Greg or Rebecca McClimans 525 N Betty Ln INSURER C:FCCI Clearwater, FL 33755 INSURER D: INSURER E: INSURER F: 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 TYPE OF INSURANCE DDL UBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X CPP00117591 10/01/12 10/01/13 DAMAGE TO RENTED 100 000 PREMISES Ea occurrence $ , CLAIMS-MADE OCCUR 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 X POLICY PRO LOC $ JECT AUTOMOBILE LIABILITY CEa aOMBINED SINGLE LIMIT ccident $ 1,000,000 C X ANY AUTO CA00170601 10/01/12 10/01/13 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 C EXCESS LAB CLAIMS-MADE UMB00114901 10/01/12 10/01/13 AGGREGATE $ 1,000,000 DED X RETENTION$ 0 $ WORKERS COMPENSATION X WC STATU- OH_ AND EMPLOYERS'LIABILITY TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N Z070895702 10/01/12 10/01/13 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 C Equipment Floater CM00059011 10/01/12 10/01/13 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) City of Clearwater is listed as additional insured with respect to general liability subject to the terms, conditions and exclusions of the policy. CERTIFICATE HOLDER CANCELLATION CITYCLE 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. Parks &Recreation Dept. 100 So Myrtle Ave AUTHORIZED REPRESENTATIVE Clearwater, FL 33756 _kc,4 t o At_1J— ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD