CERTIFICATE OF LIABILITY INSURANCE (250)AICO ��� DATE (MMIDD/YYYY)
V CERTIFICATE OF LIABILITY INSURANCE 3/4/'2013
PRODUCER (201) 262-1200 FAX: (201) 262-7810 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Fenner & Esler ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EX'TEND OR
467 Kinderkamack Road , ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. 0. Box 60
Oradell NJ 07649-0060 INSURERSAFFORDINGCOVERAGE NAliw#
INSURED INSURER A: CY1dTt2Y' Oak Fire Insurance 2561�s
Biller Reinhart Structural Group, Inc. INSURERB:EVHZ'eSt National Insurance ioiao
3434 COLWELL AVENUE, SUITE 100 INSURERC:
Tampa i FL 33614
rnvcowr_ce
INSURER D:
INSURER E:
v THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTIMTHI•STANDING
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 CONDITIOIJS 05UCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR DD' POLICYNUMBER POLICYEFFECTIVE pPOTCYEXPIRATION LIMITS
C .
GENERALLIABIUTY EACHOCCURRENCE $ :8,000�000
X COMMERCIALGENERALLIABILITY PREMISES Eaoccurrence $ .L.000 000
A CLAIMSMADE �X OCCUR 680-8783L610-COF-13 3/1/2013 3/1/2014 MEDEXP(Anyoneperson) $ _ 10 000
PERSONAL&ADVINJURY $ �,000,000
GENERALAGGREGATE $ �,000 000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ �i 000, O00
X POLICY PR� LOC _
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
(Ea accident) $ .L, 000, 000
ANY AUTO .
A ALLOWNEDAUTOS 680-8783L610-COP-13 3�1�2013 3/1/2014 gODILYINJURY $
SCHEDULED AUTOS (Per person)
X HIRED AUTOS 80DILY INJURY
(Per accident) $
X NON-OWNED AUTOS �� ����� _
PROPERTY DAMAGE $
(Per accidenq
GARAGE LIABIIITY �,Q ^� g`': `Ti'j m} AUTO ONLY - EA ACCIDENT $
�$ 3�
ANY AUTO "���� ���� i OTHER THAN EA ACC 3 _
AUTO ONLY: qGG $
EXCESS / UMBRELLA LIABILITY 'i � '°�' �" �'� � � EACH OCCURRENCE $
p � . �. � A*'� �� "�"� -
OCCUR � CLAIMS MADE �,�°t„�",��vErf c.s s� �- ��°�� �� � AGGREGATE 3 _
$
DEDUCTIBLE $ .
RETENTION $ $ .
WORKERSCOMPENSATION WCSTATU- OTH-
AND EMPLOYERS' LIABILITY y� N - -
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED7
(1Vlandatory in NM) E.L. DISEASE - EA EMPLOYE $ _
If yes, describe under
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $
B OTHERprOf@8810Ad1 9A8000318-131 3/1/2013 3/1/2014 Per Claim Limit ,1.,000�000
Liability xnnual aggregate :L, 000, 000
DESCRIPTION OF OPERATIONS / LOCATIONS / V EHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Addltional Insured - Certificate Holder as respects general liability where required by written contract.
City of Clearwater
Attn: City Clerk
PO Box 4748
Clearwater, FL 33756-4748
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TFNE 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, 11'S AGENTS OR
AUTHORIZED REPRESENTATIVE
Esler/JEAN
/ i —
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INS025 �zoosoi�.oi ��� �� The ACORD name and logo are registered marks of ACORD ��v vv•• v��• �v...
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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.
AGORD 25 (2009/01)
INS025 �zooeoi�.oi