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CERTIFICATE OF LIABILITY INSURANCE (612),a►c=o � CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) `,..� oti2aiza,s 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 AITER 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 HO�DER. 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 CONTACT MARSH USA, INC. NAME: TWO ALLIANCE CENTER PHONE Fnx 3560 LENOX ROAD, SUITE 2400 E•MAIL ac No : ATLANTA,GA 30326 ADDRESS: �^ 100492-HomeD-GAW-15-16 INSURED HOME DEPOT U.S.A., INC. DIB/A THE HOME DEPOT 2455 PACES FERRY ROAD, NW BUILDING C-20 ATLANTA, GA 30339 iNSUReR n: Steadfast Insurance Company - INSURER B; ZUfIC�I AR1CfIC2f1 If1SUf8f1C2 CO wsuReR c: New Hampshire ins Co S,� wsuReR o: Illinois National Insurance Company '9/�� INSURER E : 9I �., F t6535 23841 23817 COVERAGES CERTIFICATE NUMBER: ATL-003150632-05 REVISION NUMBER:O THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEIOW 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 1MTH RESPECT TO WHICH THIS CERTIF�CATE 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. L�MITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY GLO4887714-05 O3/O1I2O15 O3IO1/2016 EACH OCCURRENCE $ 9,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 1,000,000 CLAIMS-MADE � OCCUR LIMITS OF POLICY XS MED EXP (Any one person) g EXCLUDED OF SIR: $1M PER OCC PERSONAL & ADV INJURY $ 9,000,000 GENERAL AGGREGATE $ 9,000,000 GEN'L AGGREGATE LIMIT APPLIES PER�. PRODUCTS - COMP/OP AGG $ 9,000,000 X POLICY PR� LOC $ B AUTOMOBILE LIABILITY � BAP Z938i3F)3-1L O31O1120i5 O3101/2010 ��MBINED SINGLE L!MIT 1,000,000 Ea accident . X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED � SCHEDULED SELf INSURED AUTO PHY DMG eODIIY �NdURY (Per accident -S AUTOS AUTOS ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS _ AUTOS Per accident $ $ UMBRELLA LIAB OCCUR . EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ C WORKERSCOMPENSATION WC017731493 (AOS) 03I01/2�15 03��1/2016 X WCSTATU- OTH- AND EMPLOYERS' LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE Y� N WC017731495 (AK, KY, NH, NJ, VT) 03I01I2015 O3IO'IIZO16 'I,OOO,OOO OFFICER/MEMBER EXCLUDED? ❑N N/ A E.L EACH ACCIDENT $ � (Mandatory in NH) WC017731494 (FL) 03/01/2015 03I01/2016 1,000,000 E.L DISEASE - EA EMPLOYEE $ If yes, describe under Conitnued on Addi6onal Pa e DESCRIPTION OF OPERATIONS below 9 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Atlditional Remarks Schedule, if more space is required) Ref: Larry Middleton- CGC1506911 & Dominick Montalbano-CGC1506093, Vince Lanigan- CGC1512641 CITY OF CLEARWATER IS INCLUDED AS AN ADDITIONAL INSURED IF REQUIRED BY WRITTEN CONTRACT ON THE ABOVE GENERAL LIABILITY POLICY, BUT ONLY WITH RESPECT TO LIABILtTY ARISING OUT OF THE OPERATIONS OF THE NAMED INSURED. CERTIFICATE HOLDER ceucG� � ATIA41 CITY OF CLEARWATER 100 SOUTH MYRTLE AVE. CLEAftWATER, FL 33756 ACORD 25 (2010/05) 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 REPRESEN7ATIVE of Marsh USA Inc. Manashi Mukherjee ..�.a,h,�.ue>M.: �_,,,,�,�.�„ �O 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD � �. � �. � � .� �� 0064-01-00-0002777•0002•0008675 ACORO� �..�— AGENCY AGENCY CUSTOMER ID: 100492 LOC #: Atlanta ADDITIONAL REMARKS SCHEDULE Page 2 of 2 NAMEDINSURED MARSH USA, INC. HOME DEPOT U.S.A., INC. �,r �C� D/B/A THE HOME DEPOT n F�L POLICY NUMBER 2455 PACES FERRY ROAD, /� l F BUILDING G20 ��J',f- • � �� ATLANTA, GA 30339 �� CARRIER NAIC CODE EFFECTIVE DATE: 9l C ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, l FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers CompensaGon Con6nued: Carrier: New Hampshire Ins Co Policy Number: WC017731496 (WI) Effective Date: 03/01/2015 Expiration Date: 03/01/2016 (EL) Limit: $1,000,000 Carrier: Nationat Union Fire Insurance Company Policy Number: WC9883951 (�SI) Effective Date:03101/2015 Expiration Date: 03/01/2016 (EL) Limit: $1,000,000 SIR: $1,000,000 SIR for the states of AZ, CA, CO3 IL, ME, MI, NC ,NV, OH, OR, PA, UT, VA,WA .P,750,000 SIR forthe state of GA $350,000 SIR for the state of CT Carrier: National Union FireJnsurance Company Policy Number: WC9883952 (QSI) (MA) Effective Date: 03/01/15 Expiratbn Date: 03/01/76 (EL) Limit: $1,000,000 SIR:$500,000 TX Employers XS Indemnity: Carrier. Illinois Union Ins Co Policy Number: TNS C4813�948 (TX) Effective Dale: 03/01/15 Expiration Date: 03I01/16 (EL) Limit: $10,000,000 SIR: $1,000,000 "' HOME DEPOT INSUREDS"` Home Depot USA, Inc. dba The Home Depot Home Depot U.S.A., Inc. dba Home Decorators Collection THD At Home Services, Inc. dba The Home Depot Al-Home Services THD Al-Home Services, Ir�. The Home Depot, Inc. The Home Depot, Inc. Home Depot USA, Inc. Your Other Warehouse, LLC U.S. Home Systems, Inc. U.S. Remodelers, Inc. U.S. Remodelers, Inc. DBA Home Depot Interiors Home Depot of Puerto Rico, Inc. Global Cuslom Commerce. Inc. ACORD 101 (2008/01) _ __ __ O 2008 ACORD CORPORATION. All rights reserved. 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