CERTIFICATE OF LIABILITY INSURANCE (5)Y5261N12x1N12 .��4�w..
,--�
� A� °� CERTIFICATE OF LIABILITY INSURANCE D03/24/2014Y)
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, ceRain 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 CON7ACT Di8n8 Defreeuw
NAME:
M. 8. Wileoa Co., Inc. PHONE
813-229-8021 F�
(ac, No, E.q: � (ac, No�:
300 W. Platt St. E-MAIL ddefreeuwC+mewileon.com
ADDRESS:
Ste 200
Tampd, FL 33606 �NSURER�S) AfFORDING COVERAGE � NAIC X
INSURED
TLC Divereified, Inc.
2719 17th Street Hast
Palmetto, FL 34221
INSURERA: �STFIELD INS CO
INSURERB: FCCI INS CO
INSURER C :
INSURER D :
INSURER E :
24112
10178
COVERAGES CERTIFICATE NUMBER: 3e9i2841 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 �', �'�ADOLISUBRI � ��, POLICY EFF '� POLICY EXP '� LIMITS
LTR ' TYPE OF INSURANCE pOLICY NUMBER �. MMIDDIYYYY . MMIDDIYYYY '��.
A,GENERALLIABIUTY TRA3972460 ii 04/O1/14� 04/O1/15'',EACH OCCURRENGE I'�.g 1,000,000
' ' DAMAGETO RENTED
�� x�� COMMERCIAL GENERAL LIABILITY I II � II I�I II pREMISES (Ea occuvence) I$ 500, 000
I I �I CLAIMS-MADE �i X��'�.. OCCUR �� 'I I MED EXP (Any one person) �, $ 10, 000
I% I Contractual Liability j �
� ��. PERSONAL & ADV INJURY ''� S 1, 000, 000
I
i
� X I, $500 PrOH �!9 �d I � � I GENERALAGGREGATE �, $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: I I� 'I �-I PRODUCTS - COMP/OP AGG ��'. $ 2. 000 � 000
�' �'�, POLtCY �� g'.� PRO- �I R I. LOC j � I �I $
a.. AUTOMOBILELIABLLITV ITRA3972460 /Ol 1 04/Ol/ 5i COMBINEDSINGLELIMIT 'i 1,000�000
, i (Ea accident) , $
��.. X I , BODILY INJURY (Per person) �'' $
I II ANY AUTO i �
�� ALL OWNED � �'� SCHEDULED ,. I li I BODILY INJURV (Per accident) j$
I '� AUTOS I AUTOS I � . �
, . NON-OWNED � i '�PROPERTY DAMAGE
i
X X
� $
I , i Per accident
'; H�RED AUTOS II �I AUTOS '.,I , . ,. � � ,'. $
2, �I�X ,IUMBRELLALIAB I�%� OCCUR � I TRA3972460 04/O1/1�, O4/O1/15;EACHOCCURRENCE $ 5,000,000
i �
'.� EXCESS LIAB � I CLAIMS-MADE� I I AGGREGATE i$ 5, 000, 000
i i
'� DED �� X' RETENTION Y � �' � � I$
B!i WORKERSCOMPENSATION i001WC13A61661 �I 04/Ol/lSl�, X' WCSTATU- !, jOTH-'�
�iANDEMPLOYER3'UABIUN , 06/Ol/1� TORYLIMITSI �, ER I
ANY PROPRIETORIPARTNEWEXECUTIVE Y/ N li N � A I �i I E.L EACH ACCIDENT ', $ 500, 000
OFFICER/MEMBER EXCLUDED? � '��
!(Mandatory in NH) li I � I E.L DISEASE - EA EMPLOYEE $ 500, 000
�i It yes, describe under �I i '�
I DESCRIPTION OF OPERATIONS below ' ' ' �, E1. DISEASE - POLICY IIMIT I, y 500, 000
11 IInstallation Floater TRA3972460 04/O1/14 04/O1/15 $1,000 Ded 1,000,000
ITransit & Storaqe: Included
! � �Deductible: 1,000
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach I CORD 101, Additlonal Remarks Schedulq i( more space is �aquirad)
City of Cleazwater is included as an additional insured as respecta general liability
Bast Plant Anoxic Tank (09-0007-UT)
City of Cleaxwater
P.O. Box 4748
Clesiwater, FL 33758-4748
ACORD 25 (2010105)
cvoi
3a9iaaai
CANCELLATION
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 � �� � �° �
OO 1988-2070 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
i-..- �
�w
N
u.
O
�
N
O+
�
W
,.
E_���"�s-�-�
�
-�� � �� Q .
�(� ,�-��