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CERTIFICATE OF LIABILITY INSURANCE (5)UPARC ACORDr. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/26/2014 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 Bouchard Insurance 101 N Starcrest Dr. Clearwater, FL 33765 727 447 -6481 CONTACT NAME: PHONE 727 447 -6481 AX Ne 727 449 -1267 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC /t INSURER A: Granite State Insurance Co 23809 INSURED UPARC, Inc. 1501 North Belcher Rd, Ste 249 Clearwater, FL 33765 -1302 INSURER B : New Hampshire Insurance Co 23841 INSURER C : Bridgefield Casualty Ins Co 10335 INSURER D : $1,000,000 $250,000 INSURER E : MED EXP (Any one person) INSURER F : TIFICATE 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. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DCDIYEYYY) (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY Y 02LX0062640717000 12/01/2014 12/01/2015 EACH OCCURRENCE $1,000,000 $250,000 DAMAGE TO nce) MED EXP (Any one person) $ 10,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP /OP AGG $ 3,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES JECT X PER: LOC Prof. Liab. $1,000,000 B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS Y 01CA0093485147000 12/01/2014 12/01/2015 Ea COMBaccidINED ent) SI LIMIT ( 1,000,000 $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per ) $ B x UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 01 UD0007738937000 12/01/2014 12/01/2015 EACH OCCURRENCE $2,000,000 $2,000,000 $ AGGREGATE DED X RETENTION $1 0,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE L OFFICER/MEMBER EXCLUDED? NI (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below N/A 019603019 04/01/2014 04/01/2015 X TORY LIMIT TO Y LIMIT S 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 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) NOTICE: C7, (See Attached Descriptions) Li....‘..:.;....' ,. v . - . _.- CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER PO Box 4748 Clearwater, FL 33756 -0000 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) 1 of 2 #S53460/M53421 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ROBST DESCRIPTIONS (Continued from Page 1 Bouchard Insurance is required to comply with the licensing agreement we hold with ACORD. ACORD, in conjunction with the Department of Insurance, creates and enforces the rules and regulations pertaining to proper use of the Certificate of Liability Insurance form. We are required to mark a Y next to the line of business in which the Additional Insured or Waiver of Subrogation coverage applies. According to ACORD, the Description of Operations section must be limited to describing information necessary to identify the operations, locations and vehicles for which the certificate was issued. Please note the Description of Operations section of the Certificate cannot be used to add additional information except as just described. Marking a Y next to the line of business adequately documents coverage. Equally important, it satisfies the rules and regulations governing the proper use of the Certificate of Liability Insurance form. Certificate is a reflection of the current coverages provided for the insured. Limits and coverages are afforded to the certificate holder only if required by written contract. SAGITTA 25.3 (2010/05) 2 of 2 #S53460/M53421