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CERTIFICATE OF LIABILITY INSURANCE (652)ACORO� DATE06MM �D�D,/YYYY) � CERTIFICATE OF LIABILITY INSURANCE 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), AUTHORIZ�D 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 C/�'y R�� NAMEACT Aon Risk Services Northeast, Inc. (�F F�� pHONE �g66) 283-7122 F'0'X (800) 363-0105 New vork Nv offi ce (`� t�� ac. No. ex�>: 1ac. No.1: 199 water 5treet ✓ ��'`�/�� q DR�ESS: New York NY 10038-3551 USA �'�� n._ � rfiR INSURED "�/�/� ' Verizon Communications 9�� G�M and its Subsidiaries and Affiliated Co., 3 Ejvj c/o verizon Lease Administration 7701 E. Telecom Parkway Mail Code: FLTDSBIW Temple Terrace FL 33637 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: NdtlOnd� Union Fire Ins Co of Pittsburgh 19445 INSURER B: NQW Hampshi re rns Co 23841 INSURERC: I��1�O15 National rnsurance Co 23817 INSURER D: INSURER E: INSURER F: 0 d w .� m � d a O 2 COVERAGES CERTIFICATE NUMBER: 570058047427 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. Limits shown are as requested LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY �� EACH OCCURRENCE S1, OOO � OOO CLAIMS-MADE X❑ OCCUR AMA E T RE $ Z, OOO , OOO PREMISES Ea occurrence MED EXP (Any one person) $1� , 00� PERSONAL&ADVINJURY $Z,OOO,OOO N GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE SZ , OOO , OOO � X POLICY ❑ PE � ❑ LOC PRODUCTS - COMP/OP AGG S Z, OOO , OOO � 0 OTHER: � r '4 AUTOMOBILELIABILITY CA 533-95-32 06/30/2015 06/30/2016 COMBINEDSINGLELIMIT $1 00�,�� A05 Ea accident , , A X ANYAUTO CA 533-95-33 06/30/2015 06/30/2016 BODILYINJURY(Perperson) � Z ALL OWNED SCHEDULED MA BODILY INJURY (Per accident) � p AUTOS AUTOS CA 533-95-34 06/30/2015 06/30/2016 pROPERTYDAMAGE V HIREDAUTOS NON-OWNED VA Peraccident w AUTOS r � '�' X UMBRELLALIAB X OCCUR 19962013 06/30/2015 06/30/2016 EACHOCCURRENCE $1,��,�� V EXCESSLIAB CLAIMS-MADE AGGREGATE SZ,OOO,OOO DED X RETENTION 510,000 B WORKERSCOMPENSATIONAND WCO21942794 06/30/2015 06/30/2016 X STATUTE E�RH EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE Y I N AOS E.L. EACH ACCIDENT S 1� OOO � OOO B OFFICER/MEMBEREXCLUDED? � N/A wCO21942799 06/30/2015 06/30/2016 (Mandatory in NH) ry7 E.L. DISEASE-EA EMPLOYEE $1, OOO, OOO If yes, describa under DESCRIPTION OF OPERATIONS below E.L. DISCASE-POLiCY LiMiT $i , OOO , OOO - � � DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) � � � �' � � CERTIFICATE HOLDER CANCELLATION � SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE � EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE � POLICY PROVISIONS. �. CITY OF CLEARWATER FLORIDA AUTHORIZED REPRESENTATIVE SPEED CODE J180 100 SOUTH MYRTLE AVENUE ��(( �+ /� �. CLEARWATER FL 33755 USA � ii/�� ,�j ll , y�'� � e//Ot �fi1�o.TDrr e./ � 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000027366 LOC #: ACORO� �--�-- ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMEDINSURED Aon Risk Services Northeast, Inc. Verizon Communications POLICY NUMBER � See Certificate Number: 570058047427 CARRIER NAIC CODE See Certificate Number: 570058047427 EFFECTIVEDATE: NUUI I IVIYNL RCIYI/�RnJ . THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSiJRER INSLIRER INSURER .� �� O IADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD I certificate form for policy limits. POLICY POLICY INSR ADDL SUBR EFFECTIVE EXPIRATION LIMITS LTR TYPE OF INSURANCE INSD VWD pOUCY NUMBER DATE DATE MM/DD MM/DD WORKERS COMPENSATION A N/n wc021942796 06/30/2015 06/30/2016 ca B rv/n wc021942800 06/30/2015 06/30/2016 MA,ND,OH,WA,WI,WY B N/a wc021942795 06/30/2015 06/30/2016 MN C N/a wcoz1942797 06/30/2015 06/30/2016 F� ACORD 701 (2008/01) O 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD