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CERTIFICATE OF LIABILITY INSURANCE (295)OP ID: J1 '`� 2 R °A CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD /YYYY) 03/11/2014 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 Hockman Insurance Agency, Inc. 3438 Colwell Avenue Tampa, FL 33614 Hockman Insurance Agency, Inc. CONTACT Jason Travis NAME: lac °. No, Eat): 81 S- 636 -4000 FAX No): 813- 281 -1086 AE-MAIL DDRESS: PRODUCER ADVAN04 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Advanced Systems Engineering, Inc. 13555 Automobile Blvd., #330 Clearwater, FL 33762 INSURER A: Phoenix Insurance Co. 25623 INSURER B : Travelers Indemnity Co. 25658 INSURER c : Travelers Casualty & Surety Co 31194 INSURERD:Liberty Ins. Underwriters, Inc EACH OCCURRENCE INSURER E : 1,000,000 INSURER F : DAMAGE PREMISES Ea occurrence) 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. ILTR TYPE OF INSURANCE IA SR WVD POLICY NUMBER (MM /DD/YYYY) (MM/DD //YYYY) LIMITS City Of Clearwater A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR PO Box 4748 'E P'_'"', E I 660 -1 C ' - -- �� "' " } Fo r C' ° - F'"',,"''' �' 08/17/2013 08/17/2014 EACH OCCURRENCE $ 1,000,000 X DAMAGE PREMISES Ea occurrence) $ 100,000 CLAIMS -MADE X MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 7 POLICY X jE ° LOC $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 660-1C914015 08/17/2013 08/17/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,IU00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (PER ACCIDENT) $ X X $ $ g X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CUP- 3951T198 08/17/2013 08/17/2014 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DEDUCTIBLE I RETENTION $ 10,000 $ X $ C 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 UB-3951T162 08/17/2013 08/17/2014 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500 000 , D Professional Liability AEA101878 -0001 03/10/2014 03/10/2015 Per Claim Ann Agg 2,000,000 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Professional Liability coverage is written on a claims made and reported basis. Certificate holder is listed as an additional insured with respects to General Liability, Auto Liability, Excess Liability policies on a primary and non - contributory basis. Waiver of Subrogation in favor of the additional insured applies to the GL, Auto Liab,Excess Liability, & WC Policy ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CITYOFC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS. City Clerk PO Box 4748 AUTHORIZED REPRESENTATIVE Clearwater, FL 33758 -4748 I P/►t�s/ � � /�� ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD