The URL can be used to link to this page

CERTIFICATE OF LIABILITY INSURANCE (319)'4R °® CERTIFICATE OF LIABILITY INSURANCE 5A21/2014 ) 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 PrimeGroup Insurance Services, Inc. 5402 W. Laurel St. Suite 220 Tampa FL 33607 -1726 CONTACT Patty King #E131203 NAME: Y 4 (A/C. No. Es& (813)288-8270 FAx .Not: (813)885-4311 EMAIL P 4 P 4 P kin @ rime rou ins.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :National Trust Insurance 20141 INSURED TWT Restaurant Design Const & Developme 1111 North Westshore Blvd. Suite 202A Tampa FL 33607 INSURER B :Progressive Express Ins Company 10193 INSURERc:Commerce and Industry Insurance 19410 INSURER D :Star Insurance Company 18023 INSURERE:Travelers Property Casualty 25674 INSURER F : COVERAGES CERTIFICATE NUMBER:CL1452112883 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 (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY m.n.,,P'7-''1 1 i, GL0010387 5 -° 4 " r . ` "/30/014 5/30/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY I ATx I 'PT [1 LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X x SCHEDULED AUTOS NON -OWNED AUTOS �� ,,, 02235614 -1 5/30/2014 5/30/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Medical payments $ 5 , 000 C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE BE014080581 5/30/2014 5/30/2015 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 DED I RETENTION $ $ D WORKERS AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A WC0788842 01 5/30/2014 5/30/2015 WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1 , 000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 E Inland Marine 660- 2D833675 5/30/2014 5/30/2015 Leased Rented Equipment 200,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION City of Clearwater 100 S. Myrtle Avenue 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 E Ellsasser #A077187/ ACORD 25 (2010/05) NS025 (201005).01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD