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CERTIFICATE OF LIABILITY INSURANCE (584)A ORICY CERTIFICATE OF`LIABILITY INSURANCE DATE (MM o�2w) 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). PROL•U•:ER CONTACT ,,havna Chauhan NAME: Mar .h USA Inc. (A /CN No,Ext): (212) 345 -8735 (A /C No): ( 212 ) 948 -8852 1161 venue of the Americas E -MAIL Nev. Ycxk• NY 10036 ADDRESS: Please see bottom of 2nd page INSURER(S) AFFORDING COVERAGE NAIC // i -LAIMS -MADE INSURER A: AGCS Marine Insurance Company (Allianz) 22837 INSURED INSURER B: Commerce & Industry Ins Co. 19410 Master Protection, LLC d /blalter INSURER C: Illinois National Insurance Co. 23817 130 G Metro Parkway, Unit 1 INSURER D: Nat'l Union Fire Ins Co. of Pittsburgh, PA 19445 Fort Myers, FL 33966 INSURER E: New Hampshire Ins. Co. 23841 Unit -rl States = ^� COVERAGES CERTIFICATE NUMBER: 1046149 - A REVISION NUMBER: TI' C. IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD VD GATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS C:- PTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, E C LUSIONS 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 (MMIDDIYYYY) POLICY EXP (MM /DDIYYYY) LIMITS E I =ENERAL LIABILITY X I'LMMEPCIAL =EIIEPAL LIABILITY X GL 7146417 (Primary GL) 9/28/2012 10/1/2013 EACH OCCURRENCE $ $2,000,000.00 DAMAGE EMI S) RENTED PREMISES (Ea occurrence) $ $1,000,000.00 i -LAIMS -MADE X GCCUP MED EXP Any one person) $ $10,000.00 OWNER'S & CONTRACTOR'S PROT PERSONAL & ADV INJURY $ $2,000,000.00 GENERAL AGGREGATE $ $4,000,000.00 'H AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ $4,000,000.00 X I P'LLION IF�� Fi T = ^� $ AUTOMOBILE LIABILITY D D X. Am AUTO X I CA 3447245 (All Other States) CA 3447251 (MA) CA 3447254 (VA) ( ) CA 3447252 (NH) (Primary AL) 9/28/2012 9/28/2012 9/28/2012 9/28/2012 10/1/2013 10/1/2013 10/1/2013 10/1/2013 COMBINED ntS WGLE LIMIT E c $ $7,500,000.00 BODILY INJURY (Per person) $ 0 ALL �- �UVNED E _ Auros HIRED AUTOS �� -HEDU LED ALIT':, DIC'N r YinIIED AIJT iS BODILY INJURY Per accident) $ PROPERTY DAMAGE (Per accident) $ NEW HAMPSHIRE CSL $ $250,000.00 UMBRELLA LIAB X rSc,,UR CLAIMS -MADE X GL7146418(ExcessGL) CA 3447253 (NH) (Excess AL) 9/28/2012 9/28/2012 10/1/2013 10/1/2013 EACH OCCURRENCE $ $5,500,000.00 E X EXCESS LIAB AGGREGATE PRODUCTS- $ $11,000,000.00 E - DED RETENTION $ ,NNEEW HAMPSHIRE (CSL) H- TQRY LIMITS OTER $ $7,250,000.00 B V,ORKERS COMPENSATION EMPLOYERS' LIABILITY YIN C "iPRIET ERIPAPTI IET ECE� ITIVE D ER/MEMBER E` C L lC EC N E (Iandatory in NH) E deseric :e under SCPIPTIC r: OF C,PERATI ONT. beloy, NIA WC 043464663 (FL) WC 043464672 (MI) WC 043464662 (CA) (All ) WC 043464661 All Other States WC 043464673 (MN) 9128/2012 9/28/2012 9/28/2012 9/28/2012 9/28/2012 9/28/2012 10/1/2013 10/1/2013 10/1/2013 10/1/2013 10/1/2013 EL EACH ACCIDENT $ $2,000,000.00 E.L. DISEASE - EA EMPLOYEE $ $2,000,000.00 E _ DISEASE- POLICY LIMIT $ $2,000,000.00 A B'rilder's Risk/installation /Contract Works A P. -ntal Equipment /Contractor's Equipment A E.dnket Transit OC & OCW 91128600 OC & OCW 91128600 OC & OCW 91128600 9/28/2012 9/28/2012 9/28/2012 10/1/2013 USD $1,000,000.00 perjobsite 10/1/2013 USD $1,000,000.00 per jobsite 10/1/2013 USD $1,000,000.00 per conveyance DEW RI PTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) PT, r i - -r: City of Clearwater P1 • refer to attached ACORD 101 for further remarks. PLANNING D J,� J fi ;;; SEP 2 4 2012 & npt, 1 -,�,.._ YI j CEPTIFICATE HOLDER CANCELLATION PT City of Clearwater 100 S Myrtle Ave Clearwater, FL 33756 -5520 United States 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 MARSH USA INC, BY: Franklin Hallock, Global Marine Cynthia Kim, Casualty Program ACORD 25 (2010/05) Transit Program © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC' D� • AGENCY CUSTOMER ID: LOC N: ADDITIONAL REMARKS SCHEDULE Page 2 of _2._ AGENCY Marsh USA Inc. NAMED INSURED Master Protection, LLC dib /a FireMaster 13050 Metro Parkway, Unit 1 Fort Myers, FL 33966 United States POLICY NUMBER CARRIER NAIC EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE REG :,6DING POLICIES OF INSURANCE: Ins,:r -r Policy Number(s) Effective Date(s) Expiration Date(s) E WC 043464674 (MA, ND, OH, WA, WI, WY) 9/28/2012 10/1/2013 E WC 043464675 (CT,GA,PA,SC) 9/28/2012 10/1/2013 FEGPRDING NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS: Thi:- endorsement modifies the notice of cancellation of insurance provided hereunder: E o' i any of the above described policies be cancelled, other than for non - payment of premium, before the e :m I ,lion date thereof, 30 days advice of cancellation will be delivered to certificate holders in acc-,lance with the policy endorsements. Al. rher terms and conditions of this policy remain unchanged. REG7•FDING ADDITIONAL INSURED STATUS: In , iordance with the policy provisions, City of Clearwater is included as an additional insured under this polio;:, as a result of any contract or agreement entered into by the named insured and City of Clearwater. FOR QUESTIONS REGARDING THIS CERTIFICATE OF INSURANCE CONTACT: ".!a :. Vogt (Email: marvogtofiremaster- mpc.com Phone: 239- 896 -1683) THIS CERTIFICATE OF INSURANCE WAS GENERATED AND DELIVERED BY EXIGIS RiskWorks® rm.Certificates® Business Process Automation for Risk Management, Insurance, and Trade Finance To learn what EXIGIS can do for your business vied exigis.com or call 800,928.1963 ACORD 101 (2008/01) 002008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD