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CERTIFICATE OF LIABILITY INSURANCEACORD CERTIFICATE 4...- --' CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/313 1 /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 No.: (212) 488 -0200 Fax No.: (212) 488 -0220 Frenkel &Company 350 Hudson Street — 4th Floor New York, NY 10014 CONTACT NAME: PHONE FAX (NC, NA End): (AC.No): RESS: PRODUCER �$1D# INSURER(S) AFFORDING COVERAGE NAIL # INSURED Polydyne Inc. One Chemical Plant Road PO Box 250 Riceboro GA 31323 INSURER A Chartis Specialty Insurance Company 26883 INSURER B: Commerce & Industry Insurance Company 19410 INSURER C: Hartford Insurance Company of the Midwest 37478 INSURER D: National Union Fire Insurance Company of Pittsburgh PA 19445 INSURER E: MED EXP (Any one person) INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POL CY 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 TYPE OF INSURANCE NSR SUBR POLICY NUMBER POLICY EFF (MNhDD/YYYY) POLICY EXP (MMDD/YYYY) O A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X EG14362834 12/31/2013 12/31/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 500,000 MED EXP (Any one person) $ 10,000 CLAIMS MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 5,000,000 PRODUCTS- COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES 7 PRO- POLICY JECT PER: LOC $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X AUTOSULED NON -OWNED AUTOS X CA4691818 12/31/2013 12/31/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X ubURELLAUAB EXCESS LIAR X OCCUR CLAIMS MADE 13273528 12/31/2013 12/31/2014 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 $ DED I RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yesdescribe under DESCRIPTION OF OPERATIONS below N/A 1 OWNR30600 12/31/2013 12/31/2014 X ORS LIT TS I 1 0TH 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 I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) City of Clearwater is included as Additional Insured as required by contract and subject to the policy terms conditions and exclusions. 45 DAY CANCELLATION CLAUSE INCLUDED CERTIFICATE HOLDER CANCELLATION City of Clearwater City of S. Myrtle Ave. Clearwater, FL 33756 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 REPRESENTAT VE 1 ! f 1,/ j ACORD 25 (2010/05) © 1988 - 10 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of /.CORD ACORD CERTIFICATE OF LIABILITY INSURANCE f,,,,, ---- DATE 2 2/10 //10/2014 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 1NSURER(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 cond itions 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 No.: (212) 488 -0200 Fax No.: (212) 488 -0220 Frenkel & Company 350 Hudson Street — 4th Floor New York, NY 10014 CONTACT NAME: PHONE FAX (NC, No. EOh (RCA* ADS: PRODUCER CUSTONERDR INSURER(S) AFFORDING COVERAGE NAIC# INSURED Polydyne Inc. One Chemical Plant Road PO Box 250 Riceboro GA 31323 INSURER A: CHARTIS SPECIALTY INSURANCE COMPANY 26883 INSURER B: COMMERCE & INDUSTRY INSURANCE COMPANY 19410 INSURER C: HARTFORD INSURANCE COMPANY OF THE MIDWEST 37478 INSURER D: MED EXP (Any one person) INSURER E: INSURER F: CLAIMS MADE 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 POL CY 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 TYPE OF INSURANCE ADDL MR R SUER WVD POLICY NUMBER POLICY EFF IMM P000YI 12/31/2013 POLICY EXP IMM'DWYWYI 12/31/2014 LMTS EACH OCCURRENCE $ 1,000,000 A .. GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X .. EG14362834 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 500,000 MED EXP (Any one person) $ 10,000 CLAIMS MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 ., GENERAL AGGREGATE - $ 5,000,000 PRODUCTSCOMP/OP AGG $ GEN'L AGGREGATE - POLICY LIMIT APPLIES PRO- JECT PER: LOC •- $ B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X - SCHEDULED AUTOS NON -OWNED AUTOS X CA4691818 12/31/2013 12/31/2014 COMBINED SINGLE LIMIT (Ea accident) - - $ 1;000;000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X US/BRELLALAB EXCESS LIAB X OCCUR CLAIMS -MADE EGU18403155 12/31/2013 12/31/2014 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 $ DED I I RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) ryes describe under DESCRIPTION OF OPERATIONS below N/A 1OWNR30600 12/31/2013 12/31/2014 X WCS Y TATU- TOR LIMITS 0TH - ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE- EA EMPLOYEE $ 1,000,000 E.L . DISEASE - POLICY LIMIT $ 1,000,000 DESCRPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks City of Clearwater is included as Additional Insured as required by 45 DAY CANCELLATION CLAUSE INCLUDED F Schedule, if more space is required) contract and subject to the policy terms conditions and exclusions. CERTIFICATE HOLDER CANCELLATION City of Clearwater 100 S. Myrtle Ave. Clearwater, FL 33756 e an E .wia t.,.r��r §a 'CAI I ry nr. /' yr w p rm y tw° .u° 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 REEEPPRESENTA VE 1 ACORD 25 (2010/05) © 1988- ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD