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CERTIFICATE OF LIABILITY INSURANCE (490)CERTIFICATE OF LIABILITY INSURANCE CREAT -1 OP ID: C DATE (MM /DD/YYYY) 07/29/2014 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 -447 -6481 Bouchard - Clearwater Fax: 727 -449 -1267 101 Starcrest Drive P 0 Box 6090 Clearwater, FL 33758 -6090 J Raymond Bouchard, CIC NAMEACT PHONE FAX IA/C. No. Ext): (A/C, No): E-MAIL cicerts @bouchardinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : FCCI Insurance Co 10178 INSURED Creative Contractors, Inc. 620 Drew Street Clearwater, FL 33755 -4108 INSURER B :Westfield Insurance Company 24112 INSURER c : Travelers Excess &Surplus Lines 29696 INSURER D : 08/05/2015 INSURER E : $ 1,000,0 INSURER F : $ 500,0 COVERAGE 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. ILTR TYPE OF INSURANCE JNSR WVD POLICY NUMBER IMM DD/YYYY) (MMIDD/YYYY) LIMITS B GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY��t CMM1695019 ,A'' ,430 SDA IS �VSI� QNY SG ODRI WID tiOZ ` E lit 08/05/2014 h,O 08/05/2015 EACH OCCURRENCE $ 1,000,0 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 500,0 MED EXP (Any one person) $ 5,0 CLAIMS -MADE X OCCUR PERSONAL 8 ADV INJURY $ 1,000,0 GENERAL AGGREGATE $ 2,000,0 PRODUCTS - COMP /OP AGG $ 2,000,0 GEN'L AGGREGATE 7 POLICY X LIMIT APPLIES WI- PER: LOC $ B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS v SCHEDULED AUTOS NON -OWNED AUTOS A ^ CMM1695019 J cm 3D3115/2014 5/2014 08/05/2015 COMBINED SINGLE LIMIT (Ea t) $ 1,000,0 BODILY INJURY (Per person) BODILY ILY INJURY $ BODILY INJURY (Per accident) $ PROPERTY Y DAMAGE $ $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE ZUP51 M1134614NF 08/05/2014 08/05/2015 EACH OCCURRENCE $ 15,000,0 AGGREGATE $ 15,000,0 $ DED X RETENTION $ 10,000 A 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 38999 08/05/2014 08/05/2015 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 500,0 E.L. DISEASE - EA EMPLOYEE $ 500,0 E.L. DISEASE - POLICY LIMIT 500 0 $ > B Equipment Floater CMM1695019 RECEIVED 08/05/2014 08/05/2015 Lsd /Rent 75,0 Ded. 1,0 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule If more space is required) ATTN: BUILDING DEPT JUL 31 2014 OFFICIAL RECORDS AND LEGISLATIVE SRVCS DEPT CERTIFICATE HOLDER CANCELLATION CITYCLW CITY OF CLEARWATER PO BOX 4748 CLEARWATER, FL 33758 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 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD