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CERTIFICATE OF LIABILITY INSURANCE (332)TAM PSC R -01 JFAVA ,4oRO° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD,YYYY) 5/13/2014 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 ASSOCIATES AGENCY, INC. 11470 N 53rd St Temple Terrace, FL 33617 CONTACT NAME: PHONE 813 988 -1234 FAX 813 988 -0989 (A/C, No, Ext): ( ) (NC, No): ( ) ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:FCCI Commercial Ins. Co. 33472 INSURED Tampa Screens and Aluminum, Inc. & Tampa Outdoor Kitchen, LLC PO Box 272363 Tampa, FL 33688 INSURER B : FCCI INSURANCE CO. 10178 INSURER C : 12/01 /2014 INSURER D : $ 1,000,000 INSURER E : $ 100,000 INSURER F : 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 POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I R LT R TYPE OF INSURANCE INSD . VPOLICY MD POLICY NUMBER EFF (MM /DD/YYYY) POLICY EXP (MM /DDYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CPP0011780 P , .4 , r -12/01/2013 fr ; ` f ' -, �_ _ _ `i 12/01 /2014 EACH OCCURRENCE $ 1,000,000 PREM S 1-0ERa oceTu ante) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5 000 X Contractual Liab PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE POLICY OTHER: X LIMIT APPLIES PROT JEC PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED NON -OWNED AUTOS "1 d CA 0009742'1'; I h " '' "t `12101/2013 12/01/2014 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 UMB0011532 4 12/01/2013 12/01/2014 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 $ DED X RETENT ON $ 10,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER/EXECUTIVE Y OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below / N N / A 001 -WC14A -64290 05/15/2014 05/15/2015 X PER STATUTE 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 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) I City of Clearwater 100 South 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 ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD