CERTIFICATE OF LIABILITY INSURANCE (6)�
P5241N12%IN12 ^__.�. _... .
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�� CERTIFICATE OF LIABILITY INSURANCE DATE�MMIDDIYYYY)
� ACORD 03/24/2014
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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 COr+TnC7 Diana Defreeuw
NAME:
H. B. Wilson Co., Inc.
(aCNNo. E:U; 813-229-8021 i (p16, No):
300 W. Platt St. EMA�� ddefreeuw@mewilson.com
St2 200 ADDRESS:
Tampa, FL 33606 INSURER�S) AFFORDING COVERAGE �� NAIC It
INSURED
TLC Divereified, Znc.
2719 17th Street Bast
Palmetto, FL 34221
iNSURERA: �%STFIELD INS CO
INSURER B: FCCI INS CO
INSURER C :
INSURER D :
INSURER E :
24112
110178
COVERAGES CERTIFICATE NUMBER: 3e5izeo6 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 ANO CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR � TypE OF INSURANCE �'ADDL'SUBR� pOUCY NUMBER �'� MMIDD YVYY MMIDDIYYYY ��� LIMITS
LTR
A, GENErtaLLlaeluTY iTRA3972460 04/Ol/14 04/O1/15, EACHOCCURRENCE $ 1,000,000
�.' $'�. �� �� '�, i DAMAGE TO RENTED � 500� 000
�. COMMERCIAL GENERAI LIABIUTY I '� I pREMISES (Ea occurcence) '� $
��� �� CLAIMS-MADE �. x'�� OCCUR � �� i I� �li MED EXP (Any one person) �$ 10, 000
��' %�� COIItidCtu81 Llabllity � � �� I �� PERSONAL 8 ADV INJURY �, $ 1, 000, 000
I X $500 PIOp Lmg Ded I �i ;GENERALAGGREGATE !$ 2•000,000
i i ,
' GEN'L AGGREGATE LIMIT APPIIES PER. ' � i *I �I '��. PRODUCTS - COMP/OP AGG �. $ 2� 000 � 000
� � POLICY �. X �. PRO- '� % �'�, LOC � ! \� �' , �1 S
�!AUTOMOeILELUeILITV TRA3972460 � 04/O1/la 06/Ol/1 COMBWEDSINGLEUMIT i 1,000,000
. ��. I Q ,i (Ea accidenQ , $
X� , j i P` II I �, BODI�Y tNJURY (Per person) �, $
�� ANY AUTO ,
, �'. ALL OWNED , . SCHEDULED ' �i '� ! BODILY INJURY (Per accidenl) $
' � AUTOS � AUTOS � '' �
'' x��; '�, X�� NON-OWNED ; I ii I� �� pROPERTY DAMAGE �� $
. , HIRED AUTOS i �, AUTOS '� 'i , � �� (Per accWenq ;
,, . ' '.. '' ',.. ' .S
A X, UMBRELU►uAB � I, OCCUR � II TA1�3972460 � 04/Ol/14j 04/Ol/15'', EACHOCCURRENCE ,$ 5,000,000
�'�. EXCESSLIAB I CLAIMS-MADE ��. I j � ���, AGGREGATE ���, $ 5�000,000
� � DED X RETENTION $ � � I' I ''' �'�' �� $
�� WORNERS COMPENSATION WC STATU- � OTH-'�,
B i OO1WC13A61661 I 04/O1/14 04/Ol/15I X TORYLIMITS ER ,
AND EMPLOYERS' LIABILITY Y 1 N' I I i� �
ANY PROPRIETORIPARTNER/EXECUTIVE I I � I E.L EACH ACCIDENT �'. $ 500, 000
�� OfFICER/MEMBER EXCLUDED? a�. N I A�', j ', j �
' (Mandatory in NH) ��. ��, ' , �'' '', E.L DISEASE - EA EMPLOYEE. $ 500, 000
If yes, describe under ��'� '' � �! �� 500 � 000
�� DESCRIPTION Of OPERATIONS below �I ' �'�. EL. DISEASE - POLICY LIMIT �. $
l� Installation Floater i � !TRA3972Q60 � 04/O1/1 04/01/i5j$1,000 Ded 1,000,000
�, i i
i i �� ',Transit � Storage: Included
I � ',Deductible: 1,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES �Attach AGORD 101, Addltional Ramarkc 3ch�dule, if mora spaca ia requirad)
Additional Insured: TBE GrouD, Inc., 380 Park Place Boulevard, Suite 300, Clearwater, Florida 33759
CERTIFICATE HOLDER
ty of Clearwater
.O. Box 4748
learwater, FL 33758-4748
ACORD 25 (2010105)
cvoi
3e9iaso6
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
U3A � Xld/Ft-cti. � ����0
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O 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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