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CERTIFICATE OF LIABILITY INSURANCE (432)ACC11 ° CERTIFICATE OF LIABILITY INSURANCE ilkkes DATE(MM/001YYYY) 11/27/2013 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(les) 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 HUB International Insurance Services 777 Main St, Suite C -50 Fort Worth TX 76102 CONTACT PHON: Charles Reynolds E FAX PJCNNo, Ext1: (817) 820 -8100 (A/C, No): (817) 870 -0310 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURERA:Amerisure Mutual Insurance Co. 23396 INSURED (917) 920 -6173 Jimco Sales & Manufacturing, Inc. 3113 St. Louis Ave. Fort Worth TX 76110 INSURER B : Amerisure Insurance Co. 19488 INSURER C: // yagr7g ' 20 INSURERD: 12/2/2014 INSURERE: $ 1,000,000 INSURER F : $ 50,000 • Ce • 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. 1178 TYPE OF INSURANCE N R WVD POLICY NUMBER POLICY EFF (MMIDDIWWj POLICY EXP (MhVDDMfYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY CPP2058453 e��g �� s•S E 6Ft C ° ` ` // yagr7g ' 20 . 2/2013 12/2/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE I U REN I ED PREMISES (Ea occurrence) $ 50,000 CLAIMS -MADE X OCCUR MED EXP (Anyone person) $ 5,000 I PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE -7 POLICY g LIMIT APPLIES PRO - .,ECT PER: LOC PRODUCTS- COMP/OP AGG $ 2,000,000 Empl Benefits Liab $ 1,000,000 A AUTOMOBILE X LIABILITY ANY AUTO AUTOS HIRED AUTOS SCHEDULED NON -OWNED AUTOS ,�°._ C e-IC Ek- :C ae.Li'S CA2058a5�✓�®> Ai ��i,.' SZT7 d wa�� J AND / 3 12/2/2014 CO aBINEDtSINGLE LIMIT (Ea $ 1,000,000 BODILY INJURY (Per person) $ BODILY BODILYINJURY (Per acddent) $ PROPERTY DAMAGE (Per accident) $ g g X UMBRELLA LIAB EXCESSLIAB X OCCUR CLAIMS -MADE CU2058456 12/2/2013 12/2/2014 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below YJ N N IA WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A Equipment Floater IM2058454 12/2/2013 12/2/2014 Scheduled Equip $ 192,833 Leased /Rented 8 200,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) The General Liability, Auto Liability and Umbrella policies include a blanket automatic additional insured provision that provides additional insured status to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. The General Liability, Auto Liability, Umbrella policy include a blanket waiver of subrogation provision that provides a waiver of subrogation to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. The General Liability, Auto Liability and Umbrella policies include a blanket notice of cancellation to certificate holders endorsement, providing for 30 days' advance notice if the policy is canceled by the company other than nonpayment of premium, 10 days' notice after the policy is ERTIFICATE HOLDER CANCELLATION City of Clearwater 100 S. Myrtle Ave. 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 O 1988 -2010 ACORD CORPORATION. All rights reserved. • • CERTIFICATE HOLDER: DESCRIPTION OF OPERATIONS SECTION CONTINUED City of Clearwater 100 S. Myrtle Ave. Clearwater FL 33756 INSURED: Jimco Sales & Manufacturing, Inc. 3113 St. Louis Ave. Fort Worth TX 76110 DESCRIPTION OF OPERATIONS CONTINUED: canceled for nonpayment of premium. Notice is sent to the certificate holders with mailing addresses on file with the agent or company. The endorsement does not provide for notice of cancellation if the named insured requests cancellation. DATE 11/27/2013 IYY• /Afll ■)M9l