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CERTIFICATE OF LIABILITY INSURANCE (6)CREAT -1 OP ID: GD .4CORL CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 07/30/2013 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 Phone: 727 -447 -6481 Bouchard - Clearwater Fax: 727 -449 -1267 101 Starcrest Drive P 0 Box 6090 Clearwater, FL 33758 -6090 J Raymond Bouchard, CIC NAME: CT PHONE FAX (A/C. No, Ext): (A/C, No): POLICY EXP (MM /DD/YYYY) E-MAIL SS: cicerts @bouchardinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: FCCI Insurance Co 10178 INSURED Creative Contractors, Inc. 620 Drew Street Clearwater, FL 33755 -4108 INSURER B : Westfield Insurance Company 24112 INSURER C : Commerce & Industry Ins Co 19410 INSURER D : DAMAGE TO RENTED PREMISES (Ea occurrence) INSURER E : MED EXP (Any one person) INSURER F : TE 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS B GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X CMM1695 Q 19 ..,_ • 08/05/2013 08/05/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 150,000 MED EXP (Any one person) $ 10,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GE 'L AGGREGATE POLICY X LIMIT APPLIES PE PER: LOC $ B AUTOMOBILE X X LIABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS AUT SWNED • CMM1695019- • • ' -' . 308/05/2013 08/05/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Per acc dent) AMAGE $ $ C X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE BE15805662 08/05/2013 08/05/2014 EACH OCCURRENCE $ 15,000,000 AGGREGATE $ 15,000,000 $ DED X RETENT ON $ 10,000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N I A 38999 08/05/2013 08/05/2014 X WC STATU- TORY LIMITS 0TH - ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 B Equipment Floater CMM1695019 08/05/2013 08/05/2014 LSD /RENTD 100,000 DED. 1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space is required) RE PROJECT 201223: RUTH ECKERD HALL & CITY OF CLEARWATER ARE ADDITIONAL INSURED WITH RESPECTS TO GENERAL LIABILITY POLICY ONLY IF REQUIRED BY WRITTEN CONTRACT AND SUBJECT TO THE TERMS, CONDITIONS, AND LIMITS AS SPECIFIED IN THE POLICY. RUTH ECKERD HALL & CITY OF CLEARWATER 100 SOUTH MYRTLE AVENUE CLEARWATER, FL 33755 I 201223 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 1 ACORD 25 (2010/05) © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD