CERTIFICATE OF LIABILITY INSURANCE (341)ACCOR" LIABILITY i I II
VIII
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER'TIFICAT'E 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 BE' EEN THE ISSUING INSURER(S), AUTHORIZED,
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE IHODLDER.
"IMPORTANT: If the certificate holder IB an ADDITIONAL INSURED, the pollcy(les) must he endorsed. If SUBROGATION IS WAIIVED, su h; *t t e
the tern'tr5 alnd condltIon s of the Polley, certain pollcle^s map, req ulre an endorsement. A. Statement on this cer0f'icate does not counter rIg hts to the
certificate holder In lieu of such endorsement (s).
PRODUCER CA4MNT: CT A wloan 'Randolph
Lassiter-Ware Insurance of 'pampa Say PHONE g8gtii)845 -843T pax leeeyae� -ess�
1300 N. Westshore Blvd naAp �7c+anR(�lasaiter- wase.eaan
ADOM
Suite 110 INSURER(S) AFFORDING COVERAGE NAIC#
Tampa FL 3307 INSURERA,Certain. Underwriters at Lloyds
INSURED INSURER 8:
Reuben ClarsOn Consulting, Inc. INSURER C:'
750 94th Avenue North INSURER D:
Suite 213 1 INSURER E:
St. Petersburg FL 33702 1 INSURER
COVERAGES CERTIFICATE NUMBER:15 -16 Cert 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 1"0 WHICH T'Hi5
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO A.LI. THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRi A L U.: _.......- - -- --- -- ------ --- --- POCK-- ---- -F PC7LI 1f£X..F — ----------- ........_. e�..._...
LTR TYPE OF INSURANCE INSR WV0 POLICY NUMBER MMIDDIYY'YY MWDDNyYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIA . 'N L.. $ GFNERAI LihSkLITY -
CLA,W , ",AM CE [ � CK"CUR MED EXP IAny one person) $
PERSONAL & AOV INJURY $
11111, / GENERAL AGGREGATE S
.... .
GENT AG r,REC„wA4E LIMIT APPLIE'S PER: > > ' PRODUCTS . COMNOP AGG S � ..
POLICY PRO- LO i/,f $
AUTOMOBILE LIABILITY , -� I " aM ICI I u UINGI, L k IMI C
"l
...a.
ANY AUTO � 4 C�
scxiw $ —
AUTOS ED S HEDUL EL"r � I r. .._.
AUTOS
d +� II >ei rc�u4erU I $
ALL f]'WN
i
NON OVAILC: I �' wr ��� �� ifF flRFa�E ��
,�L9lL � NPd�Il iW u'
HIRED AUTOS AUrd.1:` � I '� $
r4 p ry $
UIMBRELLA LIAR OCCUR L vy < EACH I,rwIa,UF`PE'mml:Fl $
EXCESS LIAR P LAIL aA, CaE 1 AG RE(A'I "E $
DED RETENTIONS $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIE'TOR+PARTNER/EXECU'rIVE ❑ NIA
E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH E.L.. DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E'L DISEASE - POUCY LIMIT S
,A. PROFESSIONAL LIABILITY GIAMC0107304 6/5I2015 61512015 EACH CLAIM
CLAIMS MANSE AGGREGATE $1,000,000
DESCRIPTION OF OPERATIONS; LOCATIONS f VEHICLES (Attache ACORD 101, . Additional Remarks Schedule, 11 more space is required)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS.
Engineering Dept.
100 S. Myrtle Avenue AUTHORIZED REPRESENTATIVE
#220
Clearwater, FL 33756 }ry
P BcNamai t z / J13ANR
ACORD 25 (2010105) C 1988 -2010 ACORD CORPORATION', All rights reserved,
IN.R025 rlrrotnn ,,I.m Tha A,r`.f1N?rn nanna and le%nn arc ramietararl marls of Ar.r)pn