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CERTIFICATE OF LIABILITY INSURANCEOP ID: JT ACORO' �.-- CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD /YYYY) 07/31/2014 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 Hockman Insurance Agency 3438 Colwell Avenue Tampa, FL 33614 CONTACT Jason Travis PHONE FAX (a/c. No, Ext): 815- 636 -4000 (A /C, No): 813- 281 -1086 E -MAIL ADDRESS: PRODUCER ADVANO4 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Advanced Systems Engineering, Inc. 13555 Automobile Blvd., #330 Clearwater, FL 33762 INSURER A: Phoenix Insurance Co. 25623 INSURER B : Travelers Indemnity Co. 25658 INSURER c : Travelers Casualty & Surety Co 31194 INSURER D : Liberty Ins. Underwriters, Inc EACH OCCURRENCE INSURER E : 1,000,000 INSURER F : DAMAGE TO RENTED PREMISES (Ea occurrence) COVERAGES 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR W VD POLICY NUMBER POLICY EFF (MMIDD /YYYY) POLICY EXP (MM /DD/YYYY) LIMITS T A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR X X 660 -1 C914015 RECEI� AUG 0 5 2014 2014 08/17/2015 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100;000 CLAIMS -MADE X MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000;00; GENERAL AGGREGATE $ 2,000,,1 t f GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,001 7 POLICY X JECOT- LOC A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X X C�/►�� RECORDS OFFICIAL RECD 660 -1 C914011EGISLATIVE SRYCkfiN DS AND 08/17/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1'000'00 1 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (PER ACCIDENT) $ X X $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE X X CUP- 3951T198 08/17/2014 08/17/2015 EACH OCCURRENCE $ 5,000,00i AGGREGATE $ 5,000,001 DEDUCTIBLE RETENTION $ 10,000 $ X $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N N / A X UB -3951 T162 08/17/2014 08/17/2015 X WC STATU- 0TH - TORY LIMITS ER E.L. EACH ACCIDENT $ 500, , t E.L. DISEASE - EA EMPLOYEE $ 500;l I'¢, below E. L. DISEASE - POLICY LIMIT $ 500 I'k .,, >_.__. D Professional Liability AEA101878 -0001 03/10/2014 03/10/2015 Per Claim Ann Agg 2,000,! I I. 2,000,00' DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space is required) Professional Liability coverage is written on a claims made and reported basis. Certificate holder is listed as an additional insured with respects to General Liability, Auto Liability, Excess Liability policies on a Primary and non - contributory basis. Waiver of Subrogation in favor of the additional insured applies to the GL, Auto Liab,Excess Liability, & WC Policy CERTIFICATE HOLDER CANCELLATION City Of Clearwater City Clerk PO Box 4748 Clearwater, FL 33758 -4748 CITYOFC 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 ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD