CERTIFICATE OF LIABILITY INSURANCE-r�'1 �,, �
����' CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DDfYYW)
9l21/2012
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 CERIIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDI710NAL 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).
PROC�=ER Bhavna Chauhan
NAME:
Mar,h USAIf1C. A��NNo Ex :(212) 345-8735 AfC No: �212) 948-8852
116i �\venue of the Americas E-MAIL
Ne�n Ycark, NY 10036 ADDRESS: Please see bottom of 2nd page
INSURED
Tyco Integrated Security LLC.
321 �10 US Hwy 19 N
Palm Harbor, FL 34684-3727
Unii�d States
INSURER AFFORDING COVERAGE NA
INSURER A: AGCS Marine Insurance Company (Allianz) 22837
INSURER B: Commerce & Industry Ins Co. 19410
INSURER C: Illinois National Insurance Co. 23817
INSURER D: NaYI Union Fire Ins Co. of Pittsburgh, PA 19445
INSURER E: New Hampshire Ins. Co. 23841
CO�/ERAGES CERTIFICATE NUMBER:1003081 -A REVISION NUMBER:
TF�J�� 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
CLkTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
E:tCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS.
ILTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYWY MM(�lYYYY LIMRS
E �ENERAL LIABIUTY GL 7146417 (Primary GL) 9/28/2012 10/1/2013 EACH OCCURRENCE $ $2,OOQ000.00
k C��NIMERi:IAL��EhdEF'NLLIABILITY PREMISES�a ttuirence $ $1,000,000.00
?1AIM=-MADE X� GC��=UR MED EXP (Any one person) $ $10,000.00
OWNER'S & CONTRACTOR'S PROT PERSONAL & ADV INJURY $ SZ,OOO,OOO.00
_ �� 6ENERAL AGGREGATE $ $4,000,000.00
;'�YI_ Ar_-�-RE��ATE uMIT rF�FUes PER� PRODUCTS- COMP/GP AGG $ $4,000,000.00
k� r�r��i�_�,� F���=' �n�_ g
FurOMOBILE LIABIUTY 9/28/2012 1011/2013 Ea acc dent W L M g $7,�00,000.00
D CA 3447245 (All Other States)
D k� CA3447251 (MA) 9l2812012 10/1I2013 BGD�LV�NJURY�Perperson) $
ntdv vi i7r
� � �aLL �:�VVPJEG � �;!-�HEC�ULEG
E AUT�S� qUT05
0.1Cd'�.I-C��WI'�IED
k; I IIRED AUTi�'a X
AI IT���
' UMBRELLA LIAB X �,�,,i��•
E X ! EXCESSLIAB CLAIN15-MAGE
E -
I DED RETEfJTI� �Pd g'�
B u PJD EMPLOYERS' LIABILITY
� Y!N
i, FR9F'RIET4FIFAFTI9EFYE��B=UTIVE �
D �-=1�-.FFYNIFME'�EF'E��CUJC�FD" N NfA
E (�dandatoryinNH)
E � _-�.�I?seribe!inilai
=CBIFTIOPd QF S�FERATI?�f�d5 belamr
A Builder's Risk/installation/Contract Works
A ��ntal Equipment/Contractor's Equipment
A 6lanket Transit
CA 3447254 (VA)
CA 3447252 (NH) (Primary AL)
GL 7146418 (Excess GL)
CA 3447253 (NH) (Excess AL)
WC 043464672 (MI)
WC 043464662 (CA)
WC 043464661 (All Other States)
WC 043464673 (MN)
OC 8 OCW 91128600
OC 8� OCW 91128600
OC & OCW 91128600
9/28/2012 10l1/2013
9/28/2012 10/1/2013 BODILY INJURY (Per acndenq �
PROPERTY DAMAGE g
Per accitlen[
NEW HAMPSHIRE CS� �
EACH OCCURRENCE $
9/28/2012 10/1/2013 qGGREGATE PROOUCTS- $
9/28/2012 10/1/2013
NEW HAMPSHIRE (CSL) $
9/28/2012 10l1/2013 x WC STATU- oTH-
TORY IMITS R
9/28/2012 10/1Y2013 E1 EACH ACCIDENT $
9/2812012 10/1/2013
9/28/2012 10/1/2013 EL DISEASE - EA EMPLOYEE �
9/28/2012 10/1/2013 EL DISEASE- POLICY L $
9/28/2012 10/1/2013 USD$1,00O,OOD e s
9/2812012 10/1/2013 USD$1,00 er
9/28/2012 10/1/2013 USD $ , .0 r�
�ES�RIPTION OF OPERATIONS 1 LOCATIONS NEHICLES (Attach ACORD 101, Atltlltlonal Remarks Schedule, If more space is requfred)
�.�t_� ^lu�,��er: town174i263 Cuatomer Number: townl74/263 Town Numberr town174/263
��1� _- refer to attached ACORD lnl for further reniarke.
CEkTIFICATE HOLDER
City of Clearwater
100 Myrtle Avenue
Clearwater, 33756
United States
ACORD 25 (2010/OS)
CANCELLATION
$11,000,000.00
$7,250,000.00
$2,000,000.00
$2,000,000.00
$2,000,000.00
/�j� v ����1� � ��
\� S(LQ ���0�,�
� _ a.V"..�F�
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
TI1E EXPIRATION DATE TFiEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH TFIE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
;<;:�I +q:
:�� :
MARSH USA INC. BY:
(:vnfh��a Kim l:aa�alt� P�.�.ra�.
O 1988-2010 ACi
The ACORD name and logo are registered marks of ACORD
�,te.,Q� '�! '��
Franklin Hallock, Glo6al Marine
Transi[ Proc7ram
RPORATION. All rights reserved.
AGENCY CUSTOMER ID:
` • ��r.� LOC N:
'" 7
��'���� ADDITIONAL REMARKS SCHEDULE Page z ot z
��_
AGE�JCY NAME� INSURED
Marsh USA Inc. Tyco Integrated Security LLC.
POLICY NUMBER 32100 US Hwy 19 N
Palm Harbor, FL 34684-3727
United States
CARRIER NAIC
EFFECTIVE DATE:
4DDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
RE�;,-��-.'IINC, FOLICIEg OF IN6URANCE:
Ine�:._r Policy Number(s1 Effective Date(s) Expiration Date(s)
F WC 043464674 (MA, ND, OH, WA, WI, WY) 9/28/2012 10/1/2013
� WC (743464675 (CT,GA,PA,SC) 9/28/2012 10/1/2013
-EC3:F�IiVG NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS:
Thi .ndoraFment modifies the notice of cancellation of insurance provided hereunderr
�ho�_9 any oi the abovF dFSCribed policies be cancelled, other than for non-payment of premium, before the
���:7� �>.tion date thereof, 30 days advice o£ cancellation wi11 be delivered to certificate holders in
acc �3ance with thF policy endorsemen[s.
Al rhvr terms and conditiona of this policy remain unchanged.
FOR QUESTIONS REGARDING THIS CERTIFICATE OF INSURANCE CONTACT:
Mar:_yn Zimmerman (Email: mzimmermanOadt.com Phone: 613-B06-7141)
-°-----------------------------------------------------------------------°-----------------------------------°
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The ACORD name and logo are registered marks of ACORD
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