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CERTIFICATE OF LIABILITY INSURANCE (518)WAYNE -8 OP ID: DS ACGR© CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 08/25/2014 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 Phone: 407 -660 -8282 Brown & Brown of Florida, Inc. Fax: 407-660-2012 2600 Lake Lucien Dr., Ste. 330 12 Maitland, FL 32751 -7234 Tom D'Avanzo, CPA, CPCU NAMEACT Amy Manor PHONE FAX (a/C. No. Ext): (A/C, No): ADDRESS: amanor @bborlando.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Greenwich Insurance Co. 22322 INSURED Wayne Automatic Fire Sprinklers, Inc. Fire Protection Engineering 222 Capitol Ct Ocoee, FL 34761 INSURER B : Navigators Specialty Ins Co 36056 an Westfield Insurance Company INSURER C : P y 24112 INSURER D : Amerisure Insurance Company 19488 Alters America Ins. Co. INSURER E : 21296 INSURER F : $ 5,000 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 (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X X RMG64001 `/� ,n�/�p`C ��V�• • "' SEP U 2014 J RECORDS RECORDS 09/01/2014 D 09/01/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 X Contractual Liab GENERAL AGGREGATE $ 2,000,000 X GEN'L XCU Liab Per Cont PRODUCTS - COMP /OP AGG $ 2,000,000 AGGREGATE POLICY X LIMIT APPLIES JECT PER: LOC $ C AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS X X OFFICIAL OFFICIAL CMM1 EPT 09/01/2014 09/01/2015 COMBINED SINGLE LIMIT (Ea accident) $ - 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE NY14EXC169817IC 09/01/2014 09/01/2015 EACH OCCURRENCE $ 1,000,000 AGGREGATE _ $ 1,000,000 Retention $ 0 DED X RETENTION $ D 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 N / A WC2081956 WC2081958 04/01/2014 04/01/2014 04/01/2015 04/01/2015 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 E Inland Marine 1% /$1,000 Min Ded MAXA3IMO647756 RENTED /LEASED EQUIP 09/01/2014 09/01/2015 Per Item 500,000 Aggregate 750,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION I City of Clearwater Y 100 S Myrtle Avenue Clearwater, FL 33756 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 (2010/05) © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NOTEPAD INSURED'S NAME Wayne Automatic Fire WAYNE -8 OP ID: DS PAGE 2 DATE 08/25/14 ADDITIONAL INSURED- OWNERS, ADDITIONAL INSURED- OWNERS, LESSEES, CONTRACTORS- COMPLETED OPERATIONS CG 2037 0413 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US CG 2404 0509 ENDORSEMENTS CG 2038, CG 2037 AND CG 2404 APPLY AS REQUIRED BY CONTRACT, PROVIDED CONTRACT IS EXECUTED PRIOR TO LOSS LESSEES, CONTRACTORS CG 2038 0413