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CERTIFICATE OF LIABILITY INSURANCE (416)MKAUT -1 OP ID: RB '°��.. -- CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 01/17/2014 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:727- 797 -0441 HUB International Florida Fax: 727 - 669 -0673 CCF &N P.O. Box 1027 Clearwater, FL 33757 Charles F. Chunn NAMEACT PHONE FAX (A/C. No. Ext): (A/C, No): ADDRIESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Bridgefield Casualty Ins. Co. 10335 INSURED Creative Mailbox Designs, LLC dba Creative Sign Designs * *See additional page ** 12801 Commodity Place Tampa, FL 33626 INSURER B : �g{ JAN °f q�yy��gg �f 07- FIC(d`(:9- l'id A.arY'era%o l r- 51.0 E ;37,, INSURER C : "'"/ 1 INSURER D : $ INSURER E : $ INSURER F : COVERAGES CERTIFICATE 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 NU POLICY EFF ( YYY) POLICY EXP (MM /DD/YYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY �g{ JAN °f q�yy��gg �f 07- FIC(d`(:9- l'id A.arY'era%o l r- 51.0 E ;37,, 2014 {� 1 "` cs D„, "'"/ 1 EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ GE PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 'L AGGREGATE POLICY r LIMIT APPLIES JE 0 PER: LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER /MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 0196 -18875 02/01/2014 02/01/2015 v 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 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Blanket waiver of subrogation applies per form WC 00 03 13. 10 days notice of cancellation for non - payment of premium. Officers are included for coverage. CERTIFICATE HOLDER I CITYC -1 City of Clearwater Parks and Recreation 100 South Myrtel 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 /t Ocias.aL. ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NOTEPAD INSURED'S NAME Creative Mailbox Designs, LLC MKAUT -1 OP ID: RB * *dba Creative Mailbox & Sign Designs Jet Holdings, LLC WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4 -84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule *Blanket Waiver of Subrogation Applies* This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Date Prepared: December 10, 2013 Carrier: Bridgefield Casualty Insurance Company Effective Date of Endorsement: February 1, 2014 Policy Number: 196 -18875 Insured: MK Automotive Management, LLC WC 00 03 13 (Ed. 4 -84) Countersigned by. "Includes copyright material of the National Council on Compensation Insurance, Inc. used with Its permission. Copyright 1983 NCCI"