CERTIFICATE OF LIABILITY INSURANCE (2)�� �� �'" CERTIFICATE OF LIABILITY INSURANCE DATE�MMlDDIYYW)
�,,,,,,� 9/2112012
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.
INiPORTANT: 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 requlre an endorsement. A statement on thls certiflcate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PR01)Ur_ER Bhavna Chauhan
NAME:
Mar:;h USAInc. A!C No Ex :(212f 345-8735 qlC No: �212) 948-8852
116f> i\venue of the Americas e-Ma,i�
Nev� Ycxk, NY 10036 aooRess: Please see bottom of 2nd page
INSURED
Tyc�, Integrated Security LLC.
321'ip US Hwy 19 N
Pal�•� Harbor, FL 34684-3727
Unii�c: States
INSURER AFFOR�ING COVERAGE NAIC N
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:987957-A REVISION NUMBER:
Ti i:, IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
IhJ CATED. NONUITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
C:FTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
E:�G WSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS.
ILTR TYPE OF INSURANCE POLICY NUMBER MMf�DDnYYY MMIDDIYYYY LIMITS
E �eNERAL LIABILITY GL 7146417 (Primary GL) 9/28/2012 10l1/2013 EACH oCCURRENCE g $2,OOQ000.00
7. �-�-�MMER�=IAL �=EfdEF�qL UABILITY AMAGE TO REN
PREMiSES Ea occurcence S $1,OOO,DOD.00
CLFIMb-MADE X� C�CCLiR MED EXP (Any one person) $ $10,000.00
_� OWNER'S & CONTRACTOR'S PROT PERSONAL & ADV INJURY $ $2,000,000.00
J GENERALAGGREGATE $ $4,000,000.00
9d L A�;�=EE� ATE LIMIT NFFLIES PER PRODUCTS - COMPfOP AGG $ $4,000,000.00
X� p�jLl�_�/ FF! �_ �� �,_ $
.":JTOMOBILE LIABILITY M IN SING LIMI $7�500,000.00
D CA 3447245 (All Other States) 9�28�2012 10/1/2013 Ea accident �
D k�,^„���', ��i iT�, CA 3447251 (MA) 9128l2012 1011I2013 BODILY INJURY (Per person) '6
� -� a�L �_�wrdEG ��_ HEDULED CA 3447254 (VA) 9/28/2012 10I1Y2013
E � nUTC�; nUT=�S CA 3447252 (NH) (Primary AL) 9128/2012 10/1/2013 BODILY INJURY (Per accident) '6
k f�.IGPJ-S�WP�IED PRt�PERTY DAMAGE
HIREG AUT� �S %� pi iT� �'� Per accident $
� __
� UMBRELLA LIAB X : _,_�i i�
E ?' I EXCESSLIAB ��LAIbA��-MADE
E
��E�� I IFErer�iri�_�ri�
B ptJD EMPLOYERS' LIA8ILITY
C . FRC�F'FIET��RIF'HETfdEFYE�'�EGJTIVE Y�
D � -=ISERJNIEMEEF.E:�.?LLiDEC���' N NIA
E ��AandatoryinNH)
E � - �IN;�.ril.��undnr
_.�:F'IPTI�-�Pd �F �'�PEFNTI?�f�.l`�� I?elnw
A 6,iilder's RisWinstallation/Contract Works
A =��ntal Equipment/Contractor's Equipment
A 5lanket Transit
NEW HAMPSHIRE CSL � $250.000.00
EACH OCCURRENCE $ $5,500,000.00
GL 7146418 (Excess GL) 9/28/2012 10/1/2D13
CA 3447253 (NH) (Excess AL) 9/28/2012 10/1/2013 AGGREGATE PRODUCTS • $ $11,000,000.00
NEW HAMPSHIRE (CSL) g $7,250,000.00
WC 043464663 (FL) g/Zg/2012 10/1/2013 x T CY LiMITS °TR
WC 043464672 (MI) g�2g�2012 10/1/2013
WC 043464662 (CA) E1 EACH ACCIDENT � $2,000,000.00
WC 043464661 (All Other States) 9�28�2012 10/1/2013 -
WC 043464673 (MN) 9�28�2012 1011/2U13 E L DISEASE- EA EMPLOYEE $ $2,000,000.00
9/28/2012 10/1/2013 EL DISEASE- POLICY LIMIT $ 000,000.00
OC 8 OCW 91128600 9/28/2012 10/1/2013 USD $1,000,000.00 perjobsit
OC 8 OCW 91128600 9l28/2012 10/1/2013 USD $1,000,000.00 per'
OC 8 OCW 91128600 9/28Y2012 10/1/2013 USD $1,000,000, r' e e
DES�-:R��PTION OF OPERATIONS! LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
=i�_ refer te attached ACOP.D lnl for further rem�rks.
CEk71FICATE HOLDER
City of Clearwater
100 Myrtle Avenue
Clearwater, 33756
United States
ACORD 25 (2010105)
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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
QI" �e' �l ,. . �Aa.Q��'« /r �f�/�
MARSH USA INC, BV: Franklin H�Ibck, Glo6al Marine
Cynthia Wm, Casualry Program Transit P ram
O 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
. AGENCY CUSTOMER ID:
' LOC li:
_�
���+��'�''� ADDITIONAL REMARKS SCHEDULE Page z ot �
��
AGE�JCE NAMED INSURED
Mar�h USA Inc. Tyco Integrated Security LLC.
POLICY NUMBER 32100 US Hwy 19 N
Palm Harbor, FL 34684-3727
United States
CARRIER
�f1flITIC1N�l RFMGRKS
NAIC
EFFECTIVE DATE:
THIS ADDITIONAL REMARKS FORM IS A SCHEDUIE TO ACORD FORM,
FORM NUMBER: 25 FORM TI7LE: CERTIFICATE OF LIABILITY tNSURANCE
F.�c;;.�.�INr� PpLICIEB OF INfiURANCE:
In4�:r•er Policy Number(e) Effective Date(s) Expiration Date(s1
E WC 043464674 (MA, ND, OH, WA, W2, WY) 9/28/2012 10/1/2013
E WC 043464675 (CT,GA,PA,SC) 9/28/2012 10/1/2013
'..,.-='�ING NOTICE OF CANCELLATION TO CERTIFICATE HOLDERE:
T'n ndoreeiuent modifies the notice o£ cancellation of insurance provided hereunder:
�h���.i aay of thF above described policieG be cancelled, other than for non-payment of premium, before the
F>1> �:;tion date thFrFO£, 30 daye advice of cancellation will be delivered to certificate holders in
aco �3ance with the policy endorGeiuents.
A1. ;rher termc and conditione of this policy reivain unchanged.
FOR QUESTIONS REGARDING THIS CERTIFICATE OF INSURANCE CONTACT:
[�°a�_ Yn Zimmerman (Email: mzimmerman��adt.com Phone: 813-806-7141)
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IHIS CERTIFICA7E OF INSURANCE WAS GENERATED AND DELIVERED 8Y EXIGIS RiskWorks� rm.Certi(ICates�
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ACORD 101 (2008101) u[uuts �a�urcu curcrurcHi wrv. iau ngnts reservea.
The ACORD name and logo are registered marks of ACORD
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