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CERTIFICATE OF LIABILITY INSURANCE (569)'' " CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 1/21/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. HOLDER. THIS BY THE POLICIES AUTHORIZED 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 Sue Russell NAME: an. Exo: (727) 391 -9791 FAX (A /C. No): (727) 393 -5623 E -MAIL sue.russell @stahlinsurance.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Amerisure Mutual Ins Co 23396 INSURED Jeffry Knight, Inc. dba Knight Enterprises 6056 Ulmerton Rd Clearwater FL 33760 INSURER B:AmeriSUre Insurance Co 19488 INsuRERc:Travelers Property Casualty Co 25674 INSURERD: DAMAGE TO RENTED PREMISES (Ea occurrence) INSURER E: INSURER F: CLAIMS -MADE CL1512024126 • 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 WVD POLICY NUMBER POLICY EFF (MM /DD/YYYYUMM POLICY EXP /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X GL2012826 $ m ! 2014 8/17/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5 , 000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY I^IPFR-C°T nLOC PRODUCTS - COMP /OP AGG $ 2,000,000 A AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS Comprehensive X X SCHEDULED AUTOS NON -OWNED AUTOS Collision _ CA2031392 ACV-$1,000 ded Comp /Coll 8/17/2014 8/17/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILYINJURY(Peraccident) $ PROPERTY DAMAGE (Per accident) $ PIP-Basic $ 10,000 A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CU2031393 8/17/2014 8/17/2015 EACH OCCURRENCE $ 5, 000,000 AGGREGATE $ 5,000,000 DED X RETENTON$ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE (andat/MEn NHR EXCLUDED? Mandato ) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N/A WC2006779 1/31/2015 1/31/2016 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 $ 1, 000, 000 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ 1 , 000 , 000 C Inland Marine Contractors Equipment 660322X3409 8/17/2014 8/17/2015 Leased/Rented 100,000 Deductible 5, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Clearwater is included as Additional Insured as required. A 30 day notice of cancellation applies. CERTIFICATE HOLDER CANCELLATION City of Clearwater Attention: City Clerk P.O. Box 4748 Clearwater, FL 34618 -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 /RUSS ACORD 25 (2010/05) INS025 (201005).01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD