CERTIFICATE OF LIABILITY INSURANCE1 _ _ _ . __ _ _ __ _
P52ti(N12tl1N12
�,4co ' CERTIFICATE OF LIABILITY INSURANCE DATE�MMIDDIYYYY)
�� 03/24/2014
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 1-813-229-8021 CONTACT Diana Defreeuw
NAME:
N. 8. Wi18on Co., Inc.
PHONE 813-229-8021 FAX
(wc. No. Ex��; , Wc, No�:
300 W. Platt St. EMA�� ddefreeuw@mewilson.com
StC 200 ADDRESS: . . . ,
Tampa, FL 33606 INSURER�S) AFFORDING COVERAGE NAIC 6
INSURED
TLC Divereified, inc.
2719 17tL Street Hast
Palmetto, FL 34221
INSURERA: �STFIBLD INS CO
INSURER B: FCCI INS CO
INSURER C :
INSURER D :
INSURER E :
24112
10178
COVERAGES CERTIFICATE NUMBER: 3e9i2eia 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 � TYPE OF INSURANCE �ADDL�SUBR'�. pOLICY NUMBER ' M61 DDIYYYY MMIDDlYYYY � LIMITS
LTR
1► 'I GENERALLU8ILITY �, . TRA3972460 I 04/Ol/lA 04/Ol/15��, EACHOCCURRENCE '. $ 1,000,000
�, X�, !, ��, ' �; DAMAGE TO RENTED 500, 000
�� COMMERCIAL GENERAL LIABILITY ,, � Ii '�. PREMISES (Ea occurrencej ��, $
�I CLAIMS-MADE �� x''�. OCCUR �I '�. I ��, ��I MED EXP (Any one person) .$ 10, 000
I'� X i Contractual L1db111Cy �'�� '', I �'� � '� PERSONAL & ADV INJURY '$ 1, OOO, 000
I � I , I
�; X � $500 PiOp Ilmg DBd ' '��,, �I, �..� '��, GENERALAGGREGATE '� $ 2.000�000
''�� GEN'L AGGREGATE LIMIT APPLIES PER: '� li I '��. �', PRODUCTS - COMP/OP AGG � q 2. 000, 000
' '., POLICY I g . PRO- '.. II � LOC . I 'i '. ��!' �,' $
a�� AUTOMOBILE LUBILI7Y 'i � I,TRA3972460 il � A,A01 14 4 Ol/15 ��Ea aBcltleDl� INGLE LIMIT �� $ 1, 000, 000
1�t
�X
� � ANY AUTO � �� ^�R O I ! BODILY INJURY (Per person) $
�, � ALL OWNED �I SCHEDULED '�, i � '�� :� ' BODILY INJURY (Per accident) $
, � AUTOS I �� AUTOS � ! � '
�I NON-OWNED ' � ''� ' PROPERTY DAMAGE
I, x'� HIRED AUTOS ��� X,. AUTOS � II ��� '�, (Per acGdent) �� $
$
]� ' X I UMBREILALIABI x, p�CUR � �TR2.3972460 04/Ol/lp 04/O1/15 EACHOCCURRENCE I$ 5,000,000
�. �, EXCESS LIAB �'�, CLAIMS MADE �. �I I, II '�. �i AGGREGATE '� $ 5, 000, 000
�� DED X ' RETENTION $ � '� ' � �' ��.' '���. $
� WORKERS COMPENSATION . � WC STATU- � � OTH-'�
B �OO1WC13A61661 I 04/O1/1�{ 04/Ol/15', X TORYLIMITS ER ;
AND EMPLOYERS' LIABILITY ' � -
�I ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N�� I�� 'I I ' E.L EACH ACCIDENT �I $ 500, 000
��, OFFICER/MEMBER EJ(CLUDED? �'�, N 1 A'�� I I i �
��,, (Mandatory in NH) i j '�� �, �I E.L. DISEASE - EA EMPLOYEE $ 500, 000
'�, II yes, describe under i ! ' I' 500, 000
� DESCRiPT10N OF OPERATIONS below ''� �' �' � E.L DISEASE - POLICY LIMIT '�. $
A,inatallation Ploater jTRA3972460 04/O1/ly 04/01/15',$1,000 Ded 1,000,000
� I Tranait & Storage: Included
' II j I 'iDeductible: 1,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Atlaeh ACORD 101, Addilional Romarks Sch�dula, it mo�a spau is requirad)
City of Clearwater as additional insured
CERTIFICATE HOLDER
City of Clearwater
P.O. Box 4748
Clearwater, FL 33758-4748
ACORD 25 (2010105)
CVO1
38912814
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
USA I �� � ���
O 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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