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CERTIFICATE OF LIABILITY INSURANCE (629)�', ��-� r TRIAN-1 OP ID: CB ACORO�� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) �� 05/21 /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 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(sl. PRODUCER Insurance By Ken Brown, Inc. PO Box 948117 Maitland, FL 32794-8117 K. Derek Brown INSURED Triangle Pool Service Aqua Triangle I Corp dba 12801 S Belcher Rd Largo, FL 33773 K. Derek Brown t,. 321-397-3870 iNSUReRa:Amerisure Ins Company iNSURERe:Amerisure Mutual Ins. Co �NSURER C : INSURER D : INSURER F : 321-397-3888 NAIC # 19488 23396 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TypE OF INSURANCE ADDL UB POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ �,OOO,OO CLAIMS-MADE � OCCUR GL20309071101 O7/15/2015 07/15/2016 DAMA ET REN ED ��O,oO PREMISES Ea occurrence $ MED EXP (My one person) $ 5,�� PERSONAL & ADV INJURY $ �,OOO,OO GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY � ECT � LOC PRODUCTS - COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident � i��,�0 A X ANY AUTO CA12491061001 07/15/2015 07/15/2016 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Peraccident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ �,OOO,OO B EXCESS LIAB CLAIMS-MADE CU12491092202 07/15/2015 07/15/2016 AGGREGATE $ �,�0�,0� DED X RETENTION $ � $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY STATUTE, ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y� N WC131538218 01/01/2015 01/01/2016 E.�. EACH ACCIDENT $ ��00�,�� OFFICER/MEPABEP. EXCLUDED9 ❑ N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ �,��0,000 It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ ��OOO,OO DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additlonal Romarks Schedule, may be alta�hed if mora space Is requlred) FAX: 727-793-2328 RECEIVED CITY n� �� FARWATFR MAY � 6 2ti1� �ISK MAr�AGEr�F►�r CFRTIFICATF NA1 IIFR rAAIl�CI � w�r�nu City of Clearwater PO Box 4748 Clearwater, FL 33756 ACORD 25 (2014/01) CLEARWA 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 REPRESENTATIVE � w �O 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ____ `�� G� `a"� �� W C� �� 3 �� . - �� S� �� ,�P;��- �/��r� � �� k - �,..��\ ,�'� e�l L��