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CERTIFICATE OF LIABILITY INSURANCE (255)Ac•RU® CERTIFICATE OF LIABILITY INSURANCE kw. DATE(MM/DD/YYYY) 09/11/2013 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 Marsh USA, Inc. 1166 Avenue of the Americas New York, NY 10036 Attn: Walmart.certrequest@Marsh.com .148574 -G A- WC -13 -14 6420 ALARM CONTACT NAME: PHONE (A/C. No. Ext): (A/C, No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC a INSURER A : National Union Fire Insurance Company 19445 INSURED WAL -MART STORES, INC. Its Subsidiaries and Its Affiliates 702 Southwest 8th Street Bentonville, AR 72716 INSURER B : NIA N/A INSURER C : 09/15/2014 INSURER D : $ 1,000,000 INSURER E : $ 1,000,000 INSURER F : $ NIL COVERAGES CERTIFICATE NUMBER: NYC - 005828204 -14 REVISION NUMBER:1 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 EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 5302647 $1,000,000 Self - Insured Retention 09/15/2013 09/15/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ NIL 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: POLICY n JE(O.T ii LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A Workers Compensation See X WC STATU- TORY LIMITS IOTH- 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) ALARM DIVISION 05 -8749, 702 SW 8TH STREET, BENTONVILLE, AR 72716 EVIDENCE OF INSURANCE FOR ALARM CENTRAL FOR WAL -MART STORE #6420 - 2575 GULF -TO -BAY BLVD. CLEARWATER, FL 33765 CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER 100 SOUTH MYRTLE AVENUE CLEARWATER, FL 33756 I 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 of Marsh USA Inc. Laura Quackenbush at., I. " o/� ACORD 25 (2010/05) 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACCORD ® AGENCY AGENCY CUSTOMER ID: J48574 LOC #: New York ADDITIONAL REMARKS SCHEDULE Page 2 of 2 Marsh USA, Inc. POLICY NUMBER CARRIER NAIC CODE NAMED INSURED WAL -MART STORES, INC. Its Subsidiaries and Its Affiliates 702 Southwest 8th Street Bentonville, AR 72716 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance WORKERS COMPENSATION: COMPANY AFFORDING COVERAGE: ILLINOIS NATIONAL INSURANCE COMPANY EFFECTIVE: 09/15/13 - 09/15/14 POLICY NUMBER: 015630581 (MA,ND, WI) COMPANY AFFORDING COVERAGE: NEW HAMPSHIRE INSURANCE COMPANY EFFECTIVE: 09 /15/13 - 09/15/14 POLICY NUMBER: 015630576 (CO, CT, DC, IA, IN, KS, MI, NE, RI, SC, SD) POLICY NUMBER: 015630577 (DE,HI,ID,MD,MO,MS,MT,NM,NV,TN) POLICY NUMBER: 015630578 (AK, VA) POLICY NUMBER: 015630579 (NJ,PA) POLICY NUMBER: 015630580 (MN) POLICY NUMBER: 015630582 (IL, KY, NC, NH,UT, VT) COMPANY AFFORDING COVERAGE: NATIONAL UNION FIRE INSURANCE COMPANY EFFECTIVE: 09/15/13 - 09/15/14 POLICY NUMBER: 6636218 EXCESS WC ( AL, AR, AZ ,FL,GA,LA,ME,NY,OH,OK,OR,WA,WV) COMPANY AFFORDING COVERAGE: ACE AMERICAN INSURANCE COMPANY EFFECTIVE: 09/15/13 - 09/15/14 POLICY NUMBER: WLR C4 732502A (CA) ACORD 101 (2008/01) 0 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 0000569 SP 0320 - C01- P00569 -1 CITY OF CLEARWATER 100 SOUTH MYRTLE AVENUE CLEARWATER, FL 33756