CERTIFICATE OF LIABILITY INSURANCE (149)A�'��r•� � DATE (MM/DD/YYYI�
�`��� CERTIFICATE OF LIABILITY INSURANCE o5�:f1/2013
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 WAIVEq, sub�ect 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). ___
PRODUCER
Niarsh USA, Inc.
3031 N. Rodcy Point Drive West, Suite 700
Tampa, FL 33607
342881-FL-WC-13-14
INSURED
DecisionHR, Inc.
PO Box 33024
St. Petersburg, FL 33733-8024
5061
INSURER B :
INSURER C :
E:
Illinois National Insurance Company
23817
COVERAGES CERTIFICATE NUMBER: ATL-00309867fr04 REVISION NUMBER:1
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TU 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 �NSURANCE ADDL SUBR p���CY NUMBER MM/DDY/YYYY MM DDMfYY LIMITS
LTR
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY PREMISES EaEoccu ence $ _
CLAIMS-MADE � OCCUR MEO EXP (My one person) $
PERSONAL 8 ADV INJURY $
���+� GENERALAGGREGATE $ ,
��,. �w
GEN'L AGGREGATE LIMIT APPLIES PER: �' PRODUCTS - COMP/OP AGG $
POLICY PR� LOC $
AUTOMOBiLE I.IABILiTY ?"' _� COMBINED SINGLE UMIT
vy � a�'r Ea accident _
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED e �� �' ?" � `����+ �� '� �
AUTOS AUTOS -5 ��y° �'�"�° �„�,•� BODILYINJURY(Peracciderrt) $
NON-OWNED ��,,,,�,o �%+" � " �����J,,,,';`j � �.� PROPERTY DAMAGE $
HIREO AUTOS AUTOS ���,.Y,,z� �� �"' Per accident .
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGRE('iATE $
DED RETENTION $ $
A WORKERS COMPENSATION OZO72J724 06/01/2013 OB/O1/2014 X WC STATU- OTH-
AND EMPLOYERS' LIABILITY '
ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N E.L. EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? � N� A 1,000,000
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE $
�f yes, describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additlonal RemaAca Schedule, H more space is required)
Coverage is provided for only those employees leased to but not subcontractors of BillerReinhart Siructural Group, inc.
CERTIFICATE
City of Clearwater
Attention: City Clerk
P.O. Box 4748
Clearwater, FL 33758-4748
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEPORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE dELiVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Kim Arvanitis
� < `�' � . . . � � ; r ! � ' ` .y' ' s .. . : � � . u . : : _ t� ' r. <� a
O 1988-2010 ACORD CORPORATION. Ail rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
L
0004099 SP 0167 -001-P04101-�
City of Clearwater
Attention: City Clerk
P.O. Box 4748
Clearwater, FL 33758-4748 �