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CERTIFICATE OF LIABILITY INSURANCE (219)NORRI -1 OP ID: LH ACORE)° CERTIFICATE OF LIABILITY INSURANCE 41L�.� DATEIMMIDD/YYYY) 08102/2013 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- 490 -0887 Vista Insurance Alliance, LLC Fax: 727 -499 -7149 111 Second Ave NE, S# 206 St Petersburg, FL 33701 Jim Klemawesch Mr". Jim Klemawesch PHONE 727 -490 -0888 FAX No: 727 -499 -7149 lac No. Ext): E-MAIL D SS: jkiemawesch @vistains.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Westchester Surplus Lines Ins 10172 INSURED Norris & Samon Pump Service, I Joel Samon 2620 20th Ave. North St. Petersburg, FL 33713 INSURER B : Montgomery Mutual Insurance Co 14613 INSURER C : MED EXP (Any one person) INSURER D : INSURER E : CLAIMS -MADE INSURER F : OCCUR • VISION 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 SUER WVD POLICY NUMBER POLICY I DJYYYY) 08/01/2013 (MM/DD /D/YYYY) 08/01/2014 LIMITS EACH OCCURRENCE $ 1,000,000 A X X GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY G24151864 004 $1,000,000 EA—CH CLAIM 14EM SES EaEoccu ence) $ 50,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 X Professional Liab GENERAL AGGREGATE $ 2,000,000 X Blanket Add Ins PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE 7 POLICY X LIMIT APPLIES JFS T PER: LOC $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS" NON -OWNED AUTOS 01- C1- 6136142 . 08/01/2013 08/01/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILYINJURY(Perperson) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE G24151876 004 08/01/2013 08/01/2014 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 $ DED RETENTION $ 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 / A WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A Pollution Liab G24151864 004 08/01/2013 08/01/2014 Each 1,000,000 Condition DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule H more space is required) v L.fl 1 ,r 11.0,1 ,... , ,v■". CLEARWA City of Clearwater PO Box 4748 Clearwater, FL 33758 -4748 ------------- 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 4:414: ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD