CERTIFICATE OF LIABILITY INSURANCE (141)0��1 �
����� DATE (MNL'DDIYVYY)
�.� CERTIFICATE C�F LIABILITY INSURANCE 3/26/2013
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION QNLY AND CONFER5 NO RIGHTS UPON THE CERTiFICATE HOLDER. THIS '
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY A6MicND, 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 HOLUER
IMPORTANT: If the certificate holder is an ADDITIONAI INSURED. the policy�ias) musi be e�dorsed. If SUBROCaAT10Pt IS WAIVED, sub�ect t �`
the terms and condidons of the policy, certain policies may require an endorsement Astatement on this certificate does not confer rights to Uie/�i ���'�.��
i
certiflcate holder in lieu of such endorsement(a). !�
PRODUCER <�9
NAME:
SOUTH FLORIDA CASUALTY nrc, No �: 561 533-6144 A" N�>: ( 6 :�
415 North 4th Street ,;�RE� Elaine@southfloridacas .coms(/
, Lantana FL 33462 P DUCER ,��c�
/ CUSTOMER ID#: ..__. n -
INSURED ��0�0CZi SETVIC�� Inc .
P.O. Box 100846
Cape Coral, FL 33910
AFFORDING COVERAGE
INSURER A: ..�-COLLSGiS1C 1i1�uLaaavo �.
INSURER B: i�`t� T�ave3ers
�NSUaeR c: Rockhill Insurance Co.
INSURER D :
INSURER E:
INSURER F:
61
�12g%
%'799L
�8053
COVERAGES CERTIFICATENUMBER: � REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANEE LISTEO BELOW HAVE BEEN ISSUED TO THE iNSURED NAMED ABOVE FOR THE POLICY PERIOI:�
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NATH RESPECT TO WHICH THI;i
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURAtJCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TER1�1S,
EXCIUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOLVN MAY HAVE BEEN REDUCED BY PAIO CWMS.
N9R DOL UBR POLICY EFF POLICY EXP LIMITS
L7R TYPE OFINSURANCE POLICY NUMBER MNUDD/YYYY MM! _
GENER4L LIABILITY ... .. ..... ' . .. � ..� .'. � '. ... . ...�.�... :.-�-:-.... . . �. ���� EACH OCCURRENCE $ ]. O�OO � OOO
X COMMERCIAI GENERAL LIABILITY PREMISES (Ea ocwrrence) 3 I.00 � OOO
ICLAIMSMADE CI OCCUR MED EXP(Anyoneperson) $ �J � OOO
A
GEN'L AGGREGATE LIMITAPPLIESPER:
�( POLICY Ea LOC
AUTOMOBILE LIABILITY
ANYAUTO . . _. . ... .. __. .�_. . ....
ALLOWNEDAUTOS
B X SCHEDULED AUTOS
][ HIRED AUTOS
X NON-OWNED AIiTOS
UMBRELLA LIAB R OCCUR
][ EXCES3 LIAB CLAIMSMADE
A
DEDUCTIBLE
X CPSI.VZE>Jr' %1 ' ��- 03/08/13 03/08/14 pERSONALBADVINJURY $ 1� Q�00 � �0�
,,,,,, . GENER4L AGGREGATE 8 �L �OO � OOO
���? ,_ ��� :, , r� PRODUCTS - COMP/OP AGG $ 2� a O O� O OO
$
COMBINED SINGLE LIMIT
�*tl �`S � � �Yuei �. .. (Ea��M) . . $ l. � �0� � �0�
�-��
XBS0028738
BODILY INJURY (Per person) $
��µ" �� "�,� / 3 03/12/14 ��YINJURY (Peraccident) $
a*�r"3s.C.�, `f�4��..� -
u ,,.„,� , �,;�, ,,,, PROPERTY DAMAGE $
,;;��p''y/ . �=,sj" � (Per acddeM)
$
.. $ _ _._...
ea,cH OCCURRENCE a 5 CI 0 0, 0 0 0
03/08/13 03/O8/14 qGGREGA7E S 5 i �i0� � 00�
s
$
OTH-
WORKERS COMPENSATION WC STATU- �-
AND EMPLOYERS' LIABILITY Y�N � � � - ' � � � � � TORYIJMIFS � . ER .. .
ANY� PROPRIETORIPARTNEWEXECUTIVE E.L. EACH ACCIDENT 3
OFF�CEWMEMBER EXCLUDED? ❑ N�A
(MaodatorymNH) E.LDISEASE-EAEMPLOYEE $
If ye8, desaibe untler
DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $
A Installation Floater CPS1616571 osioei�3 o3ioei�a $500 , 000
C Pollution Liabilit RCPLE004796-00 o,iz9i�z 07/29/13 $1,000,000/$2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICIES (ANach ACORD tO1,Add.t onal RemarksSchedule,it morespace is required) .
HOLDER
City of Clearwater
Clearwater City Hall
Z�.Z S. O3C@018 AIPE �
Clearwater, FL 33756
�� ACQRD25 (2009/09)
E
�
F
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCQRDANCE WITH THE POLICY. PROVISIONS.
� 1988-2009 ACORDCORPORATION.AII rights rese��'ved.
The ACORD name and logo are registered marks of ACORD '