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CERTIFICATE OF LIABILITY INSURANCE (292)® A� ° CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD /YYYY) 2/4/2014 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 Stahl & Associates Insurance, Inc. r 110 Carillon Parkway St. Petersburg FL 33716 CONTACT Donna Shaw NAME: PHONE (727) 391 -9791 FAX (727)393 -5623 IA /C. No. Extl: (A/C. Nol: ADDRESS: donna.shaw @stahlinsurance.cora INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:National Trust Insurance Co LIABILITY COMMERCIAL GENERAL LIABILITY INSURED D Mar General Contracting & Development, Inc. 1453 Martin Luther King Jr. Ave S Clearwater FL 33756 INSURER B :FCCI Insurance Company GL0016398 >� m j INSURER C : 2/10/2015 INSURER D : $ 1,000,000 INSURER E : $ 300 000 INSURER F: $ 10,000 CL142420515 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 11)/VD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DDIYYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY GL0016398 >� m j 10/2014 2/10/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300 000 MED EXP (Any one person) $ 10,000 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: �I � n POLICY I IFS• PROT - n LOC $ A AUTOMOBILE X` _ — LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ _ SCHEDULED AUTOS NON -OWNED AUTOS r !. - ®. J') tv� / _ a .� 1 e,V:.1 N 'E ,aV CA0026261''Y' s o '4-' 2/10/2014 2/10/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE UMB0018338 2/10/2014 2/10/2015 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 $ DED I RETENTION $ B 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 001WC14A12335 2/10/2014 2/10 /X15 X WC STATU- TORY I IMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 $ 1,000,000 $ 1,000,000 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT B Equipment Floater CM0008022 2/10/2014 2/10/2015 Rented Equipment $100,000 Deducctible $1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CITY OF CLEARWATER 100 S MYRTLE AVE 2ND FL 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 REPRESENTATIVE Kelly Petzold /SHAW Pte— / -,-- ACORD 25 (2010/05) 1NS025 (201005).01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD