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CERTIFICATE OF LIABILITY INSURANCE (307)ACOR» CERTIFICATE OF LIABILITY INSURANCE ‘....----- DATE(MM/DD/YYYY) 03/19/2014 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 Llewellyn Insurance Services, Inc. 100 36th Ave N Saint Petersburg FL 33704 CONTACT NAME: James Klemawesch (A /c. No. EMI: (727) 894 -5555 FAX No): (727) 290 -4169 ADDRESS: jim @Llewellyninsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Rockhill Insurance Company UABILITY COMMERCIAL GENERAL LIABILITY INSURED Samon Group Inc. Norris & Samon Pump Service Inc. 2620 20th Ave North St Petersburg FL 33713 INSURER B : American States Insurance Company ',. ' ENVP00864400 MAR 2 4 L _ INSURER C : 03/13/2015 INSURER D : $ $1,000,000 INSURER E : $ $100,000 INSURER F : $ $5,000 COVERAGE 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 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. LTR TYPE OF INSURANCE INSR SUBR POLICY NUMBER (MM/DD //YYYY) (MM/DD/YYYY) LIMITS A GENERAL X UABILITY COMMERCIAL GENERAL LIABILITY Y Y ',. ' ENVP00864400 MAR 2 4 L _ ' 03/13/2014 r 0i4 03/13/2015 EACH OCCURRENCE $ $1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ $100,000 MED EXP (Any one person) $ $5,000 CLAIMS -MADE X OCCUR PERSONAL 8. ADV INJURY $ $1,000,000 GENERAL AGGREGATE $ $2,000,000 PRODUCTS - COMP /OP AGG $ $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PRO- "-R1 Al POLICY II PER: LOC $ B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS Y p�} �° R'�''��tir`�L ti`'"K°�i� //s�aee gqy L4:3i 1 �� 01-Cl-61 3614 -2 I-p 161 08/01/2013 08/01/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' UABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A I WC STATU- I TORY LIMITS I OTH- I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A Contractors Pollution Liability ENVP00864400 03/13/2014 03/13/2015 $1,000,000 Each Pollution Condition Limit $2,000,000 Aggregate Limit DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CANCELLATION I City of Clearwater P 0 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 Jim Klemawesch ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD