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CERTIFICATE OF LIABILITY INSURANCE (317)A ° CERTIFICATE OF LIABILITY INSURANCE 8/27/20 4 Y) 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 Stahl & Associates Insurance, Inc. 110 Carillon Parkway St. Petersburg FL 33716 CONTACT NAME: Sandy Barnes IPAH/no. EXn: (727) 391 -9791 1 fA /C, Noh (727) 393 -5623 E -MAIL sand bars @stahlinsurance.com ADDRESS: y n INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Hartford Casualty Insurance Co 29424 INSURED WANNEMACHER JENSEN ARCHITECTS INC 180 MIRROR LAKE DR N SAINT PETERSBUR FL 33701 INSURERB:Twin City Fire Insurance Co. 29459 INSURER C :Security National Ins Co INSURER D : CLAIMS -MADE X OCCUR INSURER E : $ 10 , 000 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1482722604 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 IN R SUBR Vn POLICY NUMBER 21SBMZ22463 RECEIVED SEP 0 POLICY EFF (MM /DD/YYYY) 8/29/2014 f� A Y 2014 POLICY EXP IMM /DD/YYYYI, 8/29/2015 LIMITS EACH OCCURRENCE $ 1,000,000 A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300, 000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10 , 000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY n PF n LOC I PRODUCTS - COMP /OP AGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED HIRED AUTOS X SCHEDULED 00-OWNED AUT OFFICIAL RECORDS 21SBMZ22463 LEG1SLATIYG AND gwa9DE p'729 /2015 COMBINED SINGLE LIMIT 1,000,000 $ BODILY IN , INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB EXCESS LIAB — OCCUR CLAIMS -MADE 21SBMz12463 8/29/2014 8/29/2015 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED X RETENTIONS 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below "/A 21wECZR6330 8/29/2014 8/29/2015 X I TORY I M TS I mil- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 $ 1,000,000 E.L. DISEASE - POLICY LIMIT C Professional Liability SES111818400 8/29/2014 8/29/2015 Each Occurrence $2,000,000 General Aggregate $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Architect of Record Agreement 14 -11 CERTIFICATE HOLDER CANCELLATION City of Clearwater P. 0. Box 4748 Clearwater, FL 33758 -4748 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 Kelly Petzold /BARNES ACORD 25 (2010/05). INS025 (201005).01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD