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CERTIFICATE OF LIABILITY INSURANCE (241)ACORE) CERTIFICATE OF LIABILITY INSURANCE 9/30/2013 DATE (MM /DD/YYYY) 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 Bowen, Miclette, Britt of Florida LLC 1020 N Orlando Avenue Suite 200 Maitland FL 32751 NAME: CONTACT Sandy Wright OO.NIJ Exn:407- 647 -1616 FAX No):407- 628 -1635 . E -MAIL ADDRESS:certificateS( bmbinc.COm INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Amerisure Insurance Company 19488 _ INSURED FOUNTAINEN Fountain Engineering, Inc. 21050 SW 172nd Avenue Miami FL 33187 INSURER B : INSURER C : INSURER D: $ INSURER E : $ INSURER F : $ ERTIFICATE 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 JMM /DD /YYYY) POLICY EXP (MM /DD/YYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ CLAIMS -MADE OCCUR PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ GEN'L AGGREGATE POLICY LIMIT APPLIES PER: Fr:T I 1 LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED NON -OWNED AUTOS (a accidentSlNGLE LIMI I _$_— $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ A WORKERS COMPENSATION ANE) EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE Yj'� OFFICER /MEMBER EXCLUDED? I (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC2078959 10/1/2013 10/1/2014 X TORY I M TS ()TH- ER E.L. EACH ACCIDENT $1 000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER CANCELLATION City of Clearwater P.O. Box 4748 Clearwater FL 33758 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 ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD