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CERTIFICATE OF LIABILITY INSURANCE (12) PAYCHEX INSURANCE AGENCY INC/PHS PO BOX 33015 SAN ANTONIO TX, 78265 The City Clearwater PO BOX 4748 CLEARWATER, FL 33758 ACORD 25 (2010/05) A�0® NKS �-� DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE R054 01-07-2013 THIS CERTIFICATEIS 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 CERTIFICATEOF 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 SUBROGATIONIS 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). PRODUCER CONTACT PAYCHEX INSURANCE AGENCY INC/PHS PHONE FAX 210703 P: (877) 287-1312 F: (888) 443-6112 E-MAILoExtl: (877) 287-1312 A/C,No): (888) 443-6112 PO BOX 33015 ADDRESS: SAN ANTONIO TX 78265 INSURERS)AFFORDING COVERAGE NAIC# INSURER A: Hartford Underwriters Ins Co INSURED INSURER B FIELDS, INC. DBA INSURER C BAREFOOT BEACHHOUSE INSURER D PO BOX 3337 CLEARWATER FL 33767 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. /NSR TYPE OF INSURANCE DDL SUER POLICY EFF POLICY EXP LIMITS LTR /NSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ CLAIMS-MADE ❑ OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO n LOC O- $ J AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED ❑ ❑ BODILY INJURY(Per accident) $ AUTOS FI AUTOS PROPERTY DAMAGE HIRED AUTOS ❑ NON-OWNED $ AUTOS (Per accident) UMBRELLA L/AB OCCUR EACH OCCURRENCE $ EXCESS L/AB CLAIMS-MADE ❑ ❑ AGGREGATE $ DE I RETENTION $ $ WORKERS COMPENSA T/ON X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY A OF ICERMPEMB RR EXCLUDED EXECUTIVE❑ NIA 76 WEG JB6739 01/04/2013 01/04/2014 E.L.EACH ACCIDENT $ 100, 000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 10 0 0 0 0 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ cj 0 0, 0 0 0 7 F DESCR/PT/ON OF OPERATIONS/LOCATIONS/VEHICLES/Attach ACORD 101,Additional Remarks Schedule,if more space is required) Those usual to the Insured' s Operations . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE The City Clearwater DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 4748 AUTHOR/ZED REPRESENTATIVE CLEARWATER, FL 33758 7th � �f © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD