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CERTIFICATE OF LIABILITY INSURANCE (628) NAP r5/15/2015_ATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE Root THIS CERTIFICATEIS 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 SUBROGATIONIS 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 NAME: NORTHEAST AGENCIES INC/PHS A"c°,NN,Ext): (866) 467-8730 (NC,No): (888) 443-6112 210619 P: (866) 467-8730 F: (888) 443-6112 ADDRIESS: 301 WOODS PARK DRIVE INSURER(S)AFFORDING COVERAGE NAIC# CLINTON NY 13323 INSURERA: Sentinel Ins Co LTD 11000 INSURED INSURER B INSURER C SOURCE INTERIORS LLC INSURERD: 420 KINGSGATE CT INSURERE: SIMPSONVILLE SC 29681 INSURER F: COVERAGES CERTIFICATE NUMBER: 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,EXCLUS IONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OFINSURANCE ADDL SUER POLICYNUMBER POLICYEFF POLICYEXP LIMITS LTR INSR WVD MM/DD/YYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s2, 000, 0 0 0 CLAIMS-MADE OCCUR DAMAGE TO RENTED $1 000, O O O PREMISES(Ea occurrence) / A X General Liab X 01 SBM UX2587 08/17/2014 08/17/2015 MED EXP(Any one person) $10, 000 PERSONAL&ADV INJURY s2, 000, 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s4, 000, 0 0 0 PRO- JECT POLICY PRO ❑X LOC PRODUCTS-COMP/OP AGG s4, 000, 0 0 0 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s2, 000, 000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ AUTO S S AUTOS A A O SCHEDULED 01 SBM UX2587 08/17/2014 08/17/2015 BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) $ $ UMBRELLA LIAB d OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPE.NSATIOry' PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) ❑ E.L.DISEASE-EA EMPLOYEE $ If yes,describe under $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured' s Operations . City of Clearwater is an Additional Insured per the Business Liability Coverage Form SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED CITY OF CLEARWATER BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ATTN• PAULA CHAPLINSKY AUTHORIZED REPRESENTATIVE PO BOX 4748 CLEARWATER, FL 33758 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD NORTHEAST AGENCIES INC/PHS 301 WOODS PARK DRIVE CLINTON NY 13323 CITY OF CLEARWATER ATTN: PAULA CHAPLINSKY PO BOX 4748 CLEARWATER FL 33758 ACORD 25(2014/01)