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CERTIFICATE OF LIABILITY INSURANCE (296)OP ID: JT At CCU? CERTIFICATE OF LIABILITY INSURANCE DATE 03(06/2015 03/06/2015 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 Hockman Insurance Agency 3438 Colwell Avenue Tampa, FL 33614 CONTACT Jason Travis PHONE FAX (A/C. No. Ext): 813- 636 -4000 (A/C, No): 813- 281 -1086 E-MAIL ADDRESS: CUSSTOOMER ID n: ADVAN04 INSURER(S) AFFORDING COVERAGE NAIC S INSURED Advanced Systems Engineering, Inc. 13555 Automobile Blvd., #330 Clearwater, FL 33762 INSURERA: Phoenix Insurance Co. 25623 INSURER B: Travelers Indemnity Co. 25658 INSURER C: Travelers Casualty & Surety Co 31194 INSURER D: Liberty Ins. Underwriters, Inc EACH OCCURRENCE INSURER E : 1,000,000 INSURER F : DAMAG l PREMISES ES (Ea RENTED occurrence) 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 WVD POLICY NUMBER POLICY EFF (MM/DDMYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR X X 660- 1C914015 REC. $ Lid 15 08/17/2014 08/17/2015 EACH OCCURRENCE $ 1,000,000 X DAMAG l PREMISES ES (Ea RENTED occurrence) $ 100,000 CLAIMS -MADE X MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 7 POLICY JECT LOC $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X X E PL.) r ° '"z`..'n +;,fr'S ui..► j !..,„ki 44 @y (,„ ,,�o',� 4.� ._ a.r` 08/17/2014 08/17/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (PER ACCIDENT) $ X X $ $ B X UMBRELLA LIAB EXCESS UAB X OCCUR CLAIMS -MADE X X CUP- 3951T198 08/17/2014 08/17/2015 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DEDUCTIBLE RETENTION $ 10,000 $ X $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS YIN N / A X UB-3951T162 08/17/2014 08/17/2015 WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 below E.L. DISEASE - POLICY LIMIT $ 500,000 D Professional Liability AEA101878 -0001 03/10/2015 03/10/2016 Per Claim Ann Agg 2,000,000 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space Is required) Professional Liability coverage is wr'tten on a claims made and reported basis. Certificate holder is lis 'ted as an additional insured with respects to General Liability, Auto Liability, Excess Liability policies on a primary and non - contributory basis. Waiver of Subrogation in favor of the additional insured applies to the GL, Auto Liab,Excess Liability, & WC Policy CERTIFICATE HOLDER CANCELLATION i CITYOFC City Of Clearwater City Clerk PO 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 �� / Gs+� ACORD 25 (2009/09) ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD