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CERTIFICATE OF LIABILITY INSURANCE (4) 74/29/2015 E(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 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). CONT PRODUCER Beecher Carlson Insurance Services NAMEACT Beecher Carlson Insurance Services 6 Concourse Parkway, Suite 2300 A/CONK Ext: 678-539-4800 A/C No: 770-870-3031 Atlanta, GA 30328 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# www.beechercarlson.com INSURERA: Ace American Insurance Company 22667 INSURED INSURER B: XL Insurance America, Inc. 24554 Coca-Cola Refreshments USA, Inc. INSURERC: Indemnity Insurance Company of North America 43575 9102 Sabal Industrial Blvd. Tampa FL 33619 INSURER D: Agri General Insurance Company 42757 INSURER E: ACE Fire Underwriters 20702 INSURER F: COVERAGES CERTIFICATE NUMBER: 24464823 REVISION 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYY MM/DD/YYY A �/ COMMERCIAL GENERAL LIABILITY HDO G27394024 5/1/2015 5/1/2016 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED CLAIMS-MADE 11/1 OCCUR PREMISES(Ea occurrence) $ 50,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 ✓ POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 5,000,000 JECT OTHER: $ INED B AUTOMOBILE LIABILITY RAID 943765502(AOS) 5/1/2015 5/1/2016 (CEO aBc d entSINGLELIMIT $ 5,000,000 v1 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C WORKERS COMPENSATION WLR C4815170A(AOS) 5/1/2015 5/1/2016 AND EMPLOYERS �/ STATUTE OERH LIABILITY' A Y/N WLRC48151711(AZ,CA,MA) 5/1/2015 5/1/2016 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 D OFFICER/MEMBER EXCLUDED? ❑N N/A WLR C48151723(TN) 5/1/2015 5/1/2016 E (Mandatory in NH) SCFC48151735(WI) 5/1/2015 5/1/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Excess WC WCU C48151693 5/1/2015 5/1/2016 Statutory Excess of $1 MM each accident (GA, LA,MI, OH,OK, OR,WA) for listed states except MA-Statutory Excess of$500,000 for each accident DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Clty of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 100 South rtle Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater F 33756-5520 AUTHORIZED REPRESENTATIVE Sharon D. Brainard ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CEAT NO.: 24464823 (ATL) Candi Joyner 4/29/2015 6:55:54 AM (EDT) Page 1 of 1