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CERTIFICATE OF LIABILITY INSURANCE (321).---- R ® A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/04/2014 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 Marsh USA, Inc. 3031 N. Rocky Point Drive West, Suite 700 Tampa, FL 33607 342881 -FL -WC -13-14 5061 CONTACT NAME: FAX IA /c No. Extl: (A/C, Nob E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Illinois National Insurance Company 23817 INSURED DeasionHR, Inc. PO Box 33024 St. Petersburg, FL 33733 -8024 INSURER B LIABILITY INSURER C : INSURER D : �° 6 � [ Ca-s r `i , INSURER E : INSURER F : $ ATL- 003098676 -10 REVISION NUMBER:1 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 WPOLICY VD POCY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) IMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR �° 6 � [ Ca-s r `i , J � '\ ` ' .,,_ EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 7 POLICY JECT LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS IY--°'.. T. t ,,,,,- .ur-4`t. i d i.. .). tom+ " 4a--.1 ^ 1 r m,11..v L;i..' COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ SCHEDULED AUTOS BODILY INJURY (Per accident) $ NON-OWNED PROPERTY DAMAGE (Per accident) $ _AUTOS $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ _ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PROPRIETOR ANY OFFICER /MEM BER /PARTNER/EX (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N N / A WC 028329029 06/01/2014 06/01/2015 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1'000,000 ECUTIVE N E.L. DISEASE - EA EMPLOYEE $ 1,000,000 below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Coverage is provided for only those employees leased to but not subcontractors of BillerReinhart Structural Group, Inc. CELLATION City of Clearwater Attention: City Clerk P.O. Box 4748 Clearwater, FL 33758 -4748 I 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 of Marsh USA Inc. Kim Arvanitis -- -"-. } D.. -u- '4 ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD