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CERTIFICATE OF LIABILITY INSURANCE (299)A� R°® CERTIFICATE OF LIABILITY INSURANCE 1 3/17/2014 D/YYYY) 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 Wallace, Welch & Willingham P.O. Box St. Petersburg FL 33733 er Petersburg CONTACT NAME: Weyman Willingham (A /C. No. Ext1:727- 522 -7777 FAX No):727- 521 -2902 E-MAIL ss:certificates w3ins.com � INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Transportation Ins Co 20494 INSURED CUM &F -1 Cumbey & Fair Inc 2463 Enterprise Rd Clearwater FL 33763 INSURER B :RetailFirst Insurance Co. INSURER C Architects & Engineers Ins Co 44148 35289 INSURER D Continental Insurance Co. /CNA INSURER E:Nat'I Fire Ins Co of Hartford 20478 INSURER F : $100,000 COVERAGES CERTIFICATE NUMBER: 760488448 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 D GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY C2086949437 -.) (\ T''';`` s s + - b- dL'.a .rz.?. IGb �14 , rl t _� rt �- - - .�:�s 3/16/2015 c .°,.� '.- 715 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 GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $2,000,000 GE 'L AGGREGATE POLICY x LIMIT APPLIES PRO- JFCT PER: LOC $ E AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED NON -OWNED AUTOS C2088208783 ., ,.G"..I �,v ��Q COMBINED SINGLE LIMIT (Ea accident) $1,000,000 $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE C2086949471 3/16/2014 3/16/2015 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 $ DED X RETENT ON $0 g 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 N I A 52024651 3/16/2014 3/16/2015 X 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 C Professional Liab Claims Made Retro Date 2/19 /2000 AEICPGI4 3/16/2014 3/17/2017 Each claim $1,000,000 Aggregate $1,000,000 Deductible $25,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Certificate holder is additional insured on a primary and noncontributory basis with respect to General Liability if required by written contract per form G17957G. Certificate holder is additional insured with respect to Auto Liability per Auto Coverage Form and on the Excess Policy subject to the underlying policy termsn and conditions. A Waiver of Subrogation in favor of Certificate Holder applies to General Liability & Auto Liability if required by written contract. CERTIFICATE HOLDER CANCELLATION City of Clearwater City Clert P.O. Box 4748 Clearwater FL 33758 -4748 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 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD