CERTIFICATE OF LIABILITY INSURANCE (256) _ FDA7,1MM1I1IYYyYY)I LI IL I �212012
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 endomement(s).
PRODUCER CONTACT Rebecca Sengaroun
Comegys Insurance Corner PHONE {727)521-2100 FAX 172 7)528-0626 rel,Florida (AIr
Contractor Insurance
-MAIL .rebeccasfcomegys..com
One Beach Drive S. E. Ste. 230 INSURER s AFFORDING COVERAGE NAtC N
Saint Petersburg FL 33701 INSURERA:First National ins Co of 24724
INSURED INSURER B:
Reuben C:larson C'onsulting,lnc -INSURER C:
972 31st Avenue N.E. INSURER D:
INSURER E
st Petersburg FL 33704 IN RERF:
COVERAGES CERTIFICATE NUMBER:12/13 GL REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTER 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 VNTH 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,
INTFk TYPE OF INSURANCE _____ POLICY NUMBER POLICY WDLI ExP_. LIMITS _ADDLSUBR
GENERAL LIABILITY EACH OCCURRENCE $ 11000.000
X COMMERCIAL GENERAL LIABILITY C3 P AMAI TO RENTED
�!�FS.[Fa���erl• t 200,000
A CLIMSWADE l.i sOCCUR 25CC29986530 3/31/2012 /31/2013 MEDEXP(Any one person) $ 10.000
PERSONAL&ADV INJURY s 11000,000
GENERAL AGGREGATE s.. .2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS COMPtOPAGG S 2,000,000
7C POLICY IRO- 17 LOC S
AUTOMOBILE LIABILITY CO r I&N E C SINGLE=M11
eEa a€cideni" -----
ANY AUTO I BODILY INJURY(Per person; ....,_
ALL OWNED 5CHEDULEO ]
AUTOS AUTOS BODILY INJURY tPor aM>w+aorvll'..S
NON-OWNED PROPERTY DAMAGE
HIRED AUTOS AUTOS �, Farac;.an�nts �$
UMBRELLA LIAR OCC '" $
OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE ATE $
OED I RETENTION 1 1 $
WORKERS COMPENSATION Ve'O l Al U- _- 101H-
AND EMPLOYERS"LIABILITY' YIN 'LIM I1
ANY PROPRIETORPPARTNERrEXECUTIVE E L EACH ACCIDENT $
OFFICERWEMBER EXCLUDEDI N 1 A -._..........-�--- -
IMandatory In NH) E L DISEASE EA EMPLOYEE $
It qqes desEnbe u4Kder
DESORIPT'ION OF OPERATIONS below E.L_DISEASE.POLICY LIMIT $
DESCRIPTION OF OPERATIONS:LOCATIONS I VEHICLES{Attach ACORD 101,Addhlonal Remarks Schedule,N more space Is requdredl
Certificate holder is included as additional insured on a primary & non-contributory basis with respects
to General Liability. Waiver of Subrogation applies..
CERTIFICATE HOLDER CANCELLATION
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.
Attention: City Clerk AUTHORIZED REPRESENTATIVE
P.O. Sox 4748
Clearwater, FL 33758-4748
Paul Smet/ SSIC
ACORD 25(2010105) (D 1988-2010 ACORD CORPORATION. All rights reserved.
IN SO2.ri on7 onvo ni T'h a,A f'nOn name+and Inn^and rrsndc4ororl mnrkc ref 9f`r'lPn