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CERTIFICATE OF LIABILITY INSURANCE
OP ID: OW '`'�,° -RL CERTIFICATE OF LIABILITY INSURANCE DATE 01 /21 /DD/YYYY) 01/21/2015 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 Fanelli - Harley- Harper & Assoc Suite 101 42 E. Lancaster Avenue Paoli, PA 19301 Kenneth R. Schultz CONTACT NAME: PHONE FAX (A/C. No. Est): (A/C, No): E-MAIL ADDRESS: PUSTUMER BURTO -1 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC it INSURED Burton & Associates, Inc. Attn: Michael Burton 200 Business Park Circle, #101 Saint Augustine, FL 32095 INSURER A: Hartford Casualty Ins. Co. 29424 INSURER B : Twin City Fire Ins. Co. 29459 INSURER C : AmGuard Insurance Company 42390 INSURER D : EACH OCCURRENCE INSURER E : 1,000,000 INSURER F : DAMAGES ( PREMISES (Ea occurrence) RENTED COVERAGES CERTIFICATE 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYYL LIMITS A GENERAL LIABIUTY COMMERCIAL GENERAL LIABILITY OCCUR 39 SBM IP 0799 01/21/2015 01/21/2016 EACH OCCURRENCE $ 1,000,000 X DAMAGES ( PREMISES (Ea occurrence) RENTED $ 300,000 CLAIMS -MADE X MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: —1 PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY X PJERCT O- . LOC $ A AUTOMOBILE LIABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 39 SBM IP 0799 01/21/2015 01/21/2016 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (PER ACCIDENT) $ X X $ $ A X UMBRELLA UAB EXCESS LIAB X OCCUR CLAIMS -MADE 39 SBM IP 0799 09/16/2015 01/21/2016 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DEDUCTIBLE RETENTION $ $ $ C WORKERS COMPENSATION EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS YIN N / A BUWC 665417 01/21/2015 01/21/2016 X WC STATU- OTH- ER TORY LIMITS E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B Errors/Omissions PG 0261365 01/21/2015 01/21/2016 Occur. Aggregate 3,000,000 3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space Is required) CERTIFICATE HOLDER CANCELLATION CLEARWT City of Clearwater Attn: Mr. Keith Bush 100 South Myrtle Avenue Clearwater, FL 33756 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 ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD