CERTIFICATE OF LIABILITY INSURANCE� � � DATE (MMIDD/YYYY)
�co�zo CERTIFICATE OF LIABILITY INSURANCE
��, 12/15/2014
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
°__S?�'Y. T.�i3 CER7IFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If thF� certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms ana conditions of the policy, certain policies may require an endorsement. A state�ent on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
_ykes losurance, Inc.
'. O. Box 2879
i�ampa FL 33601-2879
INSURED
Tampa Bay Trane
902 North Himes Ave
Tampa FL 33609
TBTRA-1
INSURER A
c
E:
COVERAGES CERTIFICATE NUMBER: 442849792 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
CFRTIFICATE 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 7ypE OF INSURANCE A D BR POLICY EFF POLICY EXP
LT IN R WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
4 GENERAL LIABILITY MM 0154905 12/31I2014 2/31/2015 EACH OCCURRENCE $1,000,000
X DAMA E TO RENTED
COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $150,000
CLAIMS-MADE � OCCUR MED EXP (Any one person) $10,000
__� _ .
� PERSONAL & ADV INJURY $1,000,
GENERAL AGGREGATE $2,000,000
' ��EN�'L AGGREG.^,TE I.IMIT APPLIES PER:
_` I PC:IC'r IX� PRO- n LOC
JECT
� � ' AUTdMOBILE LIABILITY
x �•�vY AUTO
HLLOWNED SCHEDULED
` Al�'�OS AUTOS
NON-OWNED
X � �yIRED AUTOS X AUTOS
� X PIP $10,000
'X UMBRELLA LIAB OCCUR
, cXCESS LIAB ci ninnc_n
CMM 0154905
ZUP15R6693814NF
5
PRODUCTS - COMP/OP AGG $2,000,000
$
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTYDAMAGE $
Per accident
S
2/31/2014 2131/2015 EACH OCCURRENCE
AGGREGATE
DED x RETENTION$10,000
g WJRKERSCOMPENSATION 830-52169 1l1/2015 11/2016
AND EMPLOYERS' LIABILITV Y/ N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? � N � A
(Mandatory in NH)
If yes, describe under
DESCRIPTtON OF OPERATIONS below
� Profressional Liability PL2038411214 12131/2014 2131l2015
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
City of Clearwater
112 S Osceola Ave
Clearwater FL 33756
ACORD 25 (2010/05)
RECEIV�n
A R WA TFR CANCELLA
DEC 17 2014
RISK MANAGEMENI
9
000
g10000000
g10000000
g10,000,000
E.L. EACH ACCIDENT $500,000
E.L. DISEASE - EA EMPLOYEE $500,000
E.L. DISEASE - POLICY LIMIT $500,000
Each Loss 1,000,000
GeneralAggregate 1,000,000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
173 AUTHORIZED REPRESENTATIVE
� � ' � � �� �
O 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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