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CERTIFICATE OF LIABILITY INSURANCE (266)A g �- ---- CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD /YYYY) 1/2/2014 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 Adcock - Adcock Insurance Agency Tampa pa W. Fletcher -34. Tampa FL 33612 -3414 CONTACT NAME: Radha Jones (A /C. "N EXc):$13- 933 6691 I (A/C, No1:813- 932 -6287 . ADDRESS :RadhaJ @ adcock- insurance.com A NAIC # INSURER(S) AFFORDING COVERAGE INSURER A :Southern-Owners Insurance Co. INSURER B :Praetorian Insurance Company 10190 37257 B5306 10701 INSURED 1633 CGM Services Inc 1015 E Martin Luther King Blvd Tampa FL 33603 INSURER C St Paul Fire & Marine Insurance Co INSURER D:Bridgefield Employers Ins Co INSURER E : $1,000,000 INSURER F : $50,000 CERTIFICATE NUMBER: 2066832639 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 POLICY EXP (MM/DD/YYYY) II (MMIDDIYYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 20138579 - - 1/1/2014 X1/1/2015 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $50,000 MED EXP (Any one person) $5,000 CLAIMS -MADE �] OCCUR PERSONAL 8ADV INJURY $1,000,000 _ GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OPAGG $2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER r� POLICY jX I JF� J LOC $ B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ X SCHEDULED AUTOS NON-OWNED P090000028 6/12/2013 3/12/2014 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ (Per PROPERTY DAMAGE $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE ZUP15R7437314NF 1/1/2014 '1/1/2015 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 $ DED X RETENTION $10,000 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y I NI N r A 0830 -43595 1/1/2014 /1/2015 X WC STATU- OTH- TORY LIMITS ER _E.L EACH ACCIDENT _.. E.L DISEASE - EA EMPLOYEE $1,000,000 $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CANCELLATION City of Clearwater 100 S Myrtle 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 ACORD 25 (2010/05) © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD