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LIFT STATION NO 2-2A REHABILITATION - 08-0050-UT - CERTIFICATE OF LIABILITY INSURANCE1- P52600280)2 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 03/24/2014 • 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 N. B. Wilson Co., Inc. 300 W. Platt St. Ste 200 Tampa, FL 33606 INSURED TLC Diversified, Inc. 2719 17th Street Bast Palmetto, FL 34221 1- 813 - 229 -8021 CONTACT NAME: Diana Defreeuw (Am, No, fxt): PHONE 813- 229 - 8021 (AIC, No): E-MAIL ADDRES: S ddefreeuw@mewilson.com INSURER(S) AFFORDING COVERAGE NAIL 0 INSURER A: WESTFIELD INS CO 124112 FCCI INS CO 10178 INSURER B : INSURER C : INSURER 0 : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 38912915 REVISION NUMBER: THIS INDICATED. CERTIFICATE EXCLUSIONS INSR LTR IS TO CERTIFY THAT THE POLICIES OF INSURANCE NOTWITHSTANDING ANY REQUIREMENT, MAY BE ISSUED OR MAY PERTAIN, AND CONDITIONS OF SUCH POLICIES. ADOL SUBR' TYPE OF INSURANCE INSR`MIVD LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF POLICY EXP POLICY NUMBER (MM/DDIYYYY) (MMIDDIYYYY) LIMITS A GENERAL LIABILITY X I COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X ''I OCCUR X Contractual Liability _. X $500 Prop Dmg Ded GENT_ AGGREGATE LIMIT APPLIES PER. ' POLICY ' X JEGT X �', LOC TRA3972460 APR 03 04/01/14 04/01/15' EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 500, 000 PREMISES (Ea occurtence) $ i MED EXP (Any one person) ' $ 10,000 U 1 Q (� 1 PERSONAL & ADV INJURY �'. $ 1,000,000 Ij GENERAL AGGREGATE $ 2,000,000 ! PRODUCTS - COMP /OP AGG - $ 2,000,000 $ A AUTOMOBILE mum IX ANY AUTO ALL OWNED I SCHEDULED AUTOS , !AUTOS NON -OWNED X 1 HIRED AUTOS l X i AUTOS , TRA3972460 04/01/14 04 /01 /15 COMBINED SINGLELIMIT 1,000,000 (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) A I'X I UMBRELLALIAB X OCCUR I ∎ EXCESS LIAR i CLAIMS -MADE DED ' X RETENTION $ 0 TRA3972460 T 04/01/14 04/01/15 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 $ WORKERS COMPENSATION 8 j AND EMPLOYERS' LIABILITY ''' ANY PROPRIETORIPARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) ' If yes, describe under ' DESCRIPTION OF OPERATIONS below NIA 04/01/14 04/01/15, X WC STATU- -OTH -' 001WC13A61661 TORY LIMITS', ER �'i '� E.L. EACH ACCIDENT $ 500, 000 I E.L. DISEASE - EA EMPLOYEE $ 500, 000 E . DISEASE - POLICY LIMIT $ 500, 000 A Installation Floater TRA3972460 04/01/14 (m/01/15 $1,000 Ded 1,000,000 I ! Transit & Storage: Included Deductible: 1,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) Certificate Holder Listed as Additional Insured Lift Stations 2 & 2A Rehab 08- 0050 -UT TLC Job 8 13 -09 -01 CERTIFICATE HOLDER CANCELLATION City of Clearwater P.O. Box 4748 flearwater, FL 33758 -4748 USA 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 �1 ,V', !:mtL `� .0 keg I! 0 ACORD 25 (2010/05) Cv01 38912915 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD