CERTIFICATE OF LIABILITY INSURANCE (7)i
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" '`��v!`rl' CERTIFICATE OF LIABILITY INSURANCE I 03/23/2015 Y'
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 CERT�FICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies� must be endorsed. If SUBROGATION IS WAIVED, subject to
ihe 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 ot such endorsement(s).
PRODUCER 1-813-229-8021 CON7AC7 Diana Defreeuw
M. E. Wilson Ca_. Tnc_ NAME:
300 W. Platt St.
Ste 200
Tampa, FL 33606
INSURED
TLC Diveraified, Inc.
2719 17th Street Eaat
PHONE g13-229-8021
(A/C, No, Eat):
E-MAIL
nooRESS: ddefreeuw@mewilson.com
INSURER(S) AFFORDING COVERAGE
INSURER A : �STFIHLD INS CO
1NSURER B: FCCI INS CO
INSURER C :
INSURER D :
INSURER E :
Fqx g13-229-2795
(AIC, No�:
CX'p/{-C u
24112 (J �
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Palmetto, FL 34221 INSURERF: 9�'�
COVERAGES CERTIFICATE NUMBER: 4332a99a REVISION NUMBER: v� Z
THIS IS TO CERTIFY THAT THE POLICIFS OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHS7ANDIN� ANY I�E(]UIREMENT, TERiv1 OR CONGITION OF ANY CONTRAC7 OR OfH�R DOCutvteNf WI1N RESPECT TO WHICH iNIS
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� ADOLSUBR �
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY E%P
— , IMMIDDIYYYY) (MMIDD/YYYYI LIMITS
A��.. X'�� CONMERCIALGENERALLIABILITY '�TRA3972460 �' 04/O1/15 � 04/Ol/16 EACHOCCURRENCE $ 1�000,000
i
� I �I CLAIMS-MADE X� OCCUR '. � � �� PREM SESO(Ea occur ence) $ 500, 000
X I COntrdCtudl L18billty MED EXP (Any one person) $ 10, 000
X', 5500 Prop Dmg Ded
� � . � �, ���.PERSONAL&ADVINJURV �$ 1,000,000
�,, GEN'L AGGREGATE LIMIi APPLIES PER: ', . GENERAL AGGREGATE .$ 2, 000, 000
I ���. POLICY . X . PRO- g , �. '. '�. �
,. , �.JECT LOC �, 'PRODUCTS-COMP/OPAGG'$ 2,000,000
��. OTHER�. � � ' $
A qUTOMOe1LELIAeIUTV 'TRA3972460 I04/O1/15 04/Ol/16 COMBWEDSINGLEUMIT $ 1,000,000
' �� . �. . '.. � {Ea accident)
.'. X��� ANY AUTO ��. �. ��. 80DILY INJURY (Per person) $
'. �'�. ALLOWNED �'� SCHEDULED . ', ... '... � .
��. � AUTOS � AUTOS �. I � � BODILY INJURY (Per accitlenl) $
'�. g �' �, X . NON-OWNED ', � � �. . �'� PROPERTY DAMAGE
, i HIREO AUTOS �, qUTOS ' ' . � �, �,, (Per accident) $
. , �. ,, . �, � � $
A' X', uMSRe��nuns X oCCUR TRA3972460 04/O1/15 04/O1/16
. � .. , EACH OCCURRENCE '� $ 5, 000, 000
, I EXCESS LIAB � ���� CLAIMS-MADE �
'�. i , � � , �.. I ' AGGREGATE .$ 5,000�000
� ' DED X ' RETENTION $ � '� '� � '. $
B �WORKERSCOMPENSATION �' '�,OO1WC15A61661 �.04/O1/15 �.04/O1/16 X'STATUTE � �ERH
�� AND EMPLOYERS' UABIIITY Y I N �� '� �� � � � �
IANY PROPRIETOR/PARTNER/EXECUTIVE ' � �. E1. EACH ACCIDENT �, $ 1, 000, 000
'�. OFFICER/MEMBER EXCLUDED? �'� �'1 � A , �, '� ' , ,
�(Mantlatory in NH) �� I ''�, � ��� � EL. DISEASE - EA EMPLOYEE�. $ 1, 000, 000
; If yes, �escnbe untler ��. � �, � .
I. DESCRIPTION OF OPER4TIONS below �� ' � ' EL DISEASE - POLICY LIMIT .. $ 1, 000, 000
A I,installation Floater TRA3972460 04/O1/15 ',04/O1/16 '$1,000 Ded 1,000,000
' Tranait & Storage: included
' ' Deductible: 1.000
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is requiretl)
City of Clearwater as additional insured
CERTIFICATE HOLDER
City of Clearwater
P.O. Box 4748
Clearwater, FL 33758-4748
ACORD 25 (2014101)
SD001
43324994
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVIS�ONS.
AUTHORI2ED REPRESENTATIVE
USA I ��i�71.C.�. �J. ���Gt��.(,U�'l,
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�O 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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- • M. E. Wilson Co., Inc.
= 300 W. Platt St.
~ Ste 2�0
Tampa, FL 33606
Electronic Service Requested
MIXED AADC 335
2938 ❑.8502 MB 0.432
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City of Clearwater 86
PO BOX 4748
CLEARIdATER, FL 33758-4748
EBIX BPO
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