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CERTIFICATE OF LIABILITY INSURANCE (365)WAYNE -8 OP ID: DS Accmc ` CERTIFICATE OF LIABILITY INSURANCE 1/40,.....------ DATE(MM /DDIYYYY) 03/21/2014 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 Phone: 407- 660 -8282 Brown 600 Lake Luc en Dr., Ste. 330 Fax: 407 - 660 -2012 Maitland, FL 32751 -7234 Tom D'Avanzo, CPA, CPCU arcl. Dawn Singleton (NCNN . EM): 321- 211 -2393 FAX No): E -MAIL ADDRESS: dsingleton@bborlando.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Greenwich Insurance Co. 22322 INSURED Wayne Automatic Fire Sprinklers, Inc. Hazard Fire Protection Engineering 222 Capitol Ct Ocoee, FL 34761 INSURER B : Navigators Specialty Ins Co 36056 Travelers Prop Cas Co of Amer INSURERC. 25674 INSURER D :Amerisure Insurance Company 19488 Alterra America Ins. Co. INSURER E 21296 INSURER F : MED EXP (Any one person) COVERAGES 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DDIYYYY) POLICY EXP (MM /DD /YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X X RMG640012406 P._) ' '' j .0,94,1/2013 09/01/2014 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 & ADV INJURY $ 1,000,000 X Contractual Liab GENERAL AGGREGATE $ 2,000,000 x XCU Liab Per Cont PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE POLICY X LIMIT APPLIES PRO- JECT PER: LOC $ C AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ X SCHEDULED AUTOS NON -OWNED AUTOS X )( ,v^� aa (( '�.s,�t' fir+ it, S`4� ro.o "wee t_ DT810862K721�:;,;;:f;.i5—ryt', yf[,SWii1 ,i«�� v;,.,j D 3 09/01/2014 EOa accident) SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESSLIAB X OCCUR CLAIMS -MADE NY13EXC169817IC 09/01/2013 09/01/2014 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 Retention $ 0 DED X RETENTION $ D WORKERS COMPENSATION 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 WC2081956 WC2081958 04/01/2014 04/01/2014 04/01/2015 04/01/2015 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 EL. DISEASE - EA EMPLOYEE $ 1,000,000 E . DISEASE - POLICY LIMIT $ 1,000,000 E Inland Marine 1 %/$1,000 Min Ded MAXA3IMO047766 RENTED /LEASED EQUIP 09/01/2013 09/01/2014 Per Item 500,000 Aggregate 750,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION I City of Clearwater Y 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 7,w ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NOTEPAD WAYNE -8 INSURED'S NAME Wayne Automatic Fire OP ID: DS ADDITIONAL INSURED - OWNERS, LESSEES, CONTRACTORS CG 20 33 04 13 ADDITIONAL INSURED - OWNERS, LESSEES, CONTRACTORS- COMPLETED OPERATIONS CG 20 37 04 13 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US CG 24 04 05 09 ENDORSEMENTS CG 20 33 04 13, CG 20 37 04 13 AND CG 24 04 05 09 APPLY AS REQUIRED BY CONTRACT, PROVIDED CONTRACT IS EXECUTED PRIOR TO LOSS