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CERTIFICATE OF LIABILITY INSURANCE (511)SAMPT -1 OP ID: TJ 'A� O CERTIFICATE OF LIABILITY INSURANCE DATE 08 /26D/YYYY) 08/26/14 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: 772-286-4334 Stuart Insurance, Inc. Fax: 772 - 286 -9389 3070 S W Mapp Palm City, FL 34990 Joseph E. Coons, CPCU. CIC. CONTACT PHONE FAX (A/C. No Ext): (A/C, No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : WeSCO Insurance Co LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Sampson Tree Service Co. Richard A Sampson 2170 SW Conant Ave Port Saint Lucie, FL 34953 INSURER B : Westfield Insurance 24112 INSURER C 11/10/14 INSURER D: $ 1,000,000 INSURER E : $ 100,000 INSURER F : CLAIMS -MADE ES ERTIF • 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 SUBRI W VD POLICY NUMBER M POLICY /DD/Y (M YT Y) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY WPP112450800 RECEI �/FI AUG 2 9 OFFICIAL RECORDS QQ��//((��'� 113 2014 AND `ID 11/10/14 EACH OCCURRENCE $ 1,000,000 DAMAGE TO PREMISES (RENTED Ea occurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 X GEN'L Arborists E &O GENERAL AGGREGATE $ 2,000,000 AGGREGATE POLICY LIMIT APPLIES JE� PER LOC PRODUCTS - COMP /OP AGG $ 2,000,000 Arborists $ 1,000,000 B AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS PIP 10,000 X SCHEDULED . AUTOS NON -OWNED AUTOS LEG SLATI E SRVCS LEGISLATIVE TRA0790303 DEPT 11/10/13 11/10/14 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILYINJURY(Perperson) $ BODILY INJURY (Per accident) ( ) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ 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 WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space Is required) FAX: 727 - 562 -4735 IFICATE HOLDER CITCL -2 City of Clearwater P.O. Box 4748 Clearwater, FL 33458156 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 • e,-....4_ ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD