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MARSHALL STREET SALSNES FILTER DESIGN - 06-0022-UT - CERTIFICATE OF LIABILITY INSURANCE (2)r--P5 2 6 002 800 2 201403261414 ACCORD� CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 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 M. E. Wilson Co., Inc. 300 W. Platt St. Ste 200 Tampa, FL 33606 INSURED TLC Diversified, Inc. 2719 17th Street East Palmetto, FL 34221 1- 813 - 229 -8021 CONTACT Diana Defreeuw NAME: (NC, wow): 813- 229 - 8021 FAX No): E-MAIL ADDRESS: ddefreeuwOmewilson.com INSURER(S) AFFORDING COVERAGE NAIC S INSURER A: WESTFIELD INS CO 24112 FCCI INS CO 10178 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 38912865 REVISION NUMBER: THIS INDICATED. CERTIFICATE EXCLUSIONS INSR LTR IS TO CERTIFY THAT THE POLICIES NOTWITHSTANDING ANY REQUIREMENT, MAY BE ISSUED OR MAY AND CONDITIONS OF SUCH TYPE OF INSURANCE OF INSURANCE PERTAIN, POLICIES. ADDLSUBR INSR WVD 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 LIMITS POLICY NUMBER (MMIDD/YYYYI (MMIDDIYYYYI A GENERAL X X X GEN'L LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE i X OCCUR Contractual Liability $500 Prop Dmg Ded AGGREGATE LIMIT APPLIES PER: POLICY X': JECOT i''. X ! LOC TRA3972460 04/01/14 Q 014 P� {� O 04/01/15', EACH OCCURRENCE $ 1,000,000 I DAMAGE TO RENTED 5 00, 000 I. PREMISES (Ea occurrence)'. $. Ali MED EXP (Any one person) ;. $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE '�, $ 2, 000, 000 PRODUCTS - COMPIOP AGG $ 2,000,000 $ A ( AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS TRA3972460 04/01/1 ! 04/01/15; COMBINED SINGLE LIMIT (Ea accident) 1 BODILY INJURY (Per person) BODILY INJURY (Per accident) ; PROPERTY DAMAGE : (per accident) -, $ 1,000,000 $ $ $ $ A X UMBRELLA WS EXCESS LIAB DED X RETENTION X ! OCCUR CLAIMS -MADE $ 0 TRA3972460 04/01/14 04/01/15 EACH OCCURRENCE i ''. AGGREGATE 1 $ 5,000,000 $ 5,000,000 $ H WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERJEXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N /A WC STATU- ' '10TH 'III OO1WC13A61661 04 /Ol /lq 04/01/15: X TORY LIMITS ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 : E.L. DISEASE - POLICY LIMIT : $ 500, 000 A Installation Floater TRA3972460 04/01/14 04/01/15;$1,000 Ded Transit & Storage: Deductible: 1,000,000 Included 1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder is listed as Additional Insured on all Coverage. RE Marshall Street Salsnes Filter Design 06- 0022 -UT TLC Job 120701 CERTIFICATE HOLDER CANCELLATION City of Clearwater P.O. Box 4748 (Clearwater, 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 xY SC ritt) ` l *, ACORD 25 (2010105) Cv01 38912865 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD