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CERTIFICATE OF LIABILITY INSURANCE (636)Ai VA�® �,,, CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 12/30/2014 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). PRODUCER Arthur J. Gallagher Risk Management Services, Inc. 4904 Eisenhower Blvd., Ste 250 Tampa FL 33634 CONTACT NAME: Risk Management Coordinator PHONE 813- 620 -1661 ext 261 FAX (A/c No Eat): INC. No ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Technology Insurance Company, Inc 42376 INSURED A -1 Contract Staffing, Inc., Pay Admin, LLC et al. 3829 Coconut Palm Drive Tampa, FL 33619 INSURER B : INSURER C : INSURER D : $ INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1651382911 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MDD/YYYY)_(MM/DD/YYYY) POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GE 'L AGGREGATE POLICY OTHER: LIMIT APPLIES JECOT- PER: LOC GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY accident) ( ) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A N TWC3451340 1/1/2015 1/1/2016 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS ! LOCATIONS ! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Scotto Plumbing Service, Inc. is an alternate employer. Coverage is for contracted employees of the above referenced Named Insured, not subcontracted labor. CERTIFICATE HOLDER CANCELLATION City of Clearwater 400 N Myrtle Avenue Clearwater FL 33755 USA 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 ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 003381 Arthur J. Gallagher Risk Management Services, Inc. 4904 Eisenhower Blvd, Suite 250 Tampa FL 33634 USA City of Clearwater 400 N Myrtle Ave Clearwater FL 33755 -4433 RECEIVED JAN 082015 GAS ADMIN This document was brought to you by Arthur J. Gallagher Risk Management Services, Inc. Any documents forwarded with the certificate request were reviewed for the sole purpose of completing the certificate. If you have questions regarding the content of this document, please contact the Producer /Agent listed on the certificate of insurance. The data included in this notice and in the attached document is confidential to Arthur J. Gallagher Risk Management Services, Inc.