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CERTIFICATE OF LIABILITY INSURANCE (626)� ` �:. �� DATE (MMIDDIYYYY) A�� ° CERTIFICATE OF LIABILITY INSURANCE 3/27/2015 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 ceRlflcate holder is an ADDITIONAL INSURED, the policy�les) must be endorsed. If SUBROGATION IS WAIVED, subJect to the terms and conditions of the policy, certaln 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 NAMEAC COIDID@SC131 Lines D1V1S10II Jack Rice Insurance PHONE ,(727)530-0684 pJCNo:��Z��532-9602 13080 S BelCher Rd en�no�Fee. Largo FL 33773 INSURED Tom's Sod Service, Inc. 11413 49th St N Clear::ater FL 33762 AFFORDING COVERAGE NAIC �i vst Ins. Co. 20141 antv Ins. Co. 03689 COVERAGES CERTIFICATE NUMBERCL1532739651 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. N0TIMTHSTANDING 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. �LTR TYPE OF INSURANCE ADDL SU R ��Y NUMBER MNWD EFF MOLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1� 000 � 000 A CLAIMS-MADE �X OCCUR DAMA ET RENTED 100,000 PREMISES Ea occurrence S X PD _$500 Ded per Claim GL0015214 4/1/2015 4/1/2016 MED EXP (Any one person) S 5, 000 PERSONAL & ADV INJURY y 1, 000 � 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2� 000 , 000 POLICY � �E a � LOC PRODUCTS - COMPlOP AGG S Included OTHER: Employee Banefits S 1, 000 , 000 AUTOMOBILE LIABILITY Ea accideMSINGLE LIMIT a 1, 000 , 000 A X ANY AUTO BODILY INJURY (Per person) $ ALLOWNED SCHEDULED �0023866 4/1/2015 4/1/2016 BODILYINJURY(Peraccident) S AUTOS AUTOS NON-OWNED per�accid ntDAMAGE $ HIRED AUTOS AUTOS PIP-easic a 10,000 X UMBRELLA W►B p�CUR Underlyinq:GL/Auto EACH OCCURRENCE E 3 000 000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3 000 OOO DED X RETENTION 10 000 UDID0016460 4/1/2015 4/1/2016 s WORKERS COMPENSATION PER TH- AND EMPLOYERS' LIABILITY Y� N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT E OFFICEWMEMB'cR EXCLUDED? N � A (Mandatory In NH) E.L. DISEASE - EA EMPLGYE 5 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S B INLPaND MARINE C210007501 4/1/2015 4/1/2016 Leased/Rented EquipmeM 100 � 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additlonal Remarks ScMdule, may ba atfaehed i/ more spau ia req�red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF CLEARWATER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. BOX 4748 ACCORDANCE WITH THE POLICY PROVISIONS. CLEARWATER, FL 33758-4748 AUTHORIZED REPRESENTATIVE Cynthia Webster/LPW �'�``° � � �-� O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD JNS025 r�mdon COMMENTS/REMARKS GENERAL LIABILITY: Automatic Additional Insureds when required by Written Contract With Products/Completed Operations per form CGL084 10/13. Automatic Additional Insureds when required by Written Contract Without Products/Completed Operations per form CGL088 10/13. Automatic Additional Insureds when required by Written Contract For Vendors with Products per form CGL088 10/13. Automatic Additional Insureds when required by Written Contract for Lessors (equipment) Operations only per form CGL088 10/13. Automatic Additional Insureds when required by Written Contract for Lessors (landlord) Premises only per form CGL088 10/13. Automatic Additional Insureds when required by Written Contract for Mortgagees Premises only per form CGL088 10/13. Automatic Additional Insureds when required by Written Contract for State or Governmental Agency or Subdivision or Political Subdivision-Permits or Authorizations CGL088 10/13. Waiver of Subrogation for Additional Insureds on an Automatic Basis when required by Written Contract per form CGL088 10/13. OFREMARK COPYRIGHT 2000, AMS SERVICES INC. -5��5�� U� �� ' L� J � ��- � � �� : �c��.: �'� � CP5 • �� : �:��L�� . �� e�1� \ �� ll.Q �J(�C,�� So� �c �� . �i�i�s �uC�` �� z�-c� �c� � �.�,� c� � ��; o � -�t� ,, ,� . ,,