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CERTIFICATE OF LIABILITY INSURANCE (200)AC�RD® �� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 7/22/2013 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 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 Stahl & Associates Insurance, Inc. 110 Carillon Parkway St. Petersburg FL 33716 CONTACT Maureen Rogan, CIC NAME: g , - facg% Fyn. (727)391-9791 (A/C.NZI: (727)39:3 -5623 E-MAIL maureen .rogan @stahlinsurance.com _. INSURER(S) AFFORDING COVERAGE _ NAIC # INSURER A :Ameri sure Mutual Ins CO LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Ed Seifried Construction Inc 6985 1st Avenue North St Petersburg FL 33710 INSURER B ' - : r ; -= GL2039647 INSURER C: 8/17/2014 INSURERD: $ 1,000,000 INSURER E : $ 300,000 INSURER F : $ 10,000 COVERAGES CERTIFICATE NUMBER:CL1372218428 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 VVHICH 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 LTR TYPE OF INSURANCE ADDL INSR SUBR W VD POLICY NUMBER POLICY EFF IMM /DD/YYYY) POLICY EXP (MM /DDIYYYYI LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY ' - : r ; -= GL2039647 "`" --' 8/17/2013 8/17/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300,000 MED EXP (Any one person) $ 10,000 I CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1, 000 , 000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 7POLICYInIPF FLOC $ A AUTOMOBILE UTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED NON OWNED AUTOS CA2056886 8/17/2013 8/17/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1, 000 , 000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Medical payments $ 5, 000 A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CU2039142 8/17/2013 8/17/2014 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 $ DED I X I RETENTION $ 0 A WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 2039143 8/17/2013 8/17/2014 , j WC STATU- O- ^ I TORY I IMITS I I FR Om. E.L. EACH ACCIDENT $ 1 000 000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 $ 1 000 000 E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) City of Clearwater 100 S Myrtle Ave Clearwater, FL 33756 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Kelly Petzold /ROGAN `ms. I=f.--c ` --- ACORD 25 (2010/05) INS025 (201005).01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD