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CERTIFICATE OF LIABILITY INSURANCE (660)�° � CERTIFICATE OF LIABILITY INSURANCE QDnT'^MM�IDD/YYYY) 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 certiFcate does not confer rights to the certificate holder in lieu of such endorsement s. PRODUCER T ��J. NAME: � Nallace Welch & Willingham, Inc. /� �P�C. PHONE 7� -77 ac No:7 7- 1- 300 1 st Ave. So., 5th Floor �.<` �'F E-MAIL iaint Petersburg FL 33701 s ��ii� ADDRESS: fl i. INSURED Gulf Coast Water Conditioning, Inc 13075 66th St N Largo FL 33773 �/�� ��`C ��if_'!� INSURERA CULLWAT- �, Os.. SURERB 9 ''9 'u ��,r �''��1;�.. �l NAIC # I.VVtKACitJ ctrciiricAit nunneeR:338693120 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. LTR TYPE OF INSURANCE NSR NND POLICY NUMBER MMI� DIYYYY MM D/YYYY LIMITS A GENERAL LIABILITY MPT1255T 9/1/2015 9/1/2016 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY � � DAMAGE TO RENTED PREMISES Ea occurrence $500,000 CLAIMS-MADE � OCCUR MED EXP (My one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENER4L AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY X PRO- LOC $ A AUTOMOBIIE LIABILITY B1T1255T 9/1/2015 9/1/2016 Ea accident 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AU70S Per accident $ $ A X UMBRELLA LIAB X OCCUR CUG1255T 9l1/2015 9/1/2016 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$10,000 g g WORKERS COMPENSATION WC8400031832-2015A 9/1/2015 9/1/2016 X WC STATU- OTH- AND EMPLOYERS' LIABILITY Y� N T IMIT ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? � N � A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $1,000,000 If yes, describe under DESCRIPTION UF OPERATIONS below E.L. DISEASE - POLICV LIMIT g1,C�00,000 DESCRIPTION OP OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is requlred) Named Insureds: Gulf Coast Water Conditioning, Inc., dba Culligan Water; Culligan Pinellas Water Conditioning; Culligan of Pasco/Hernando CERTIFICATE HOLDER CANCELLATION City of Clearwater 100 S. Myrtle Ave. Clearwater FL 33756 ACORD 25 (2010105) 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 f l �O 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD �j V'� �J + �� � �� � �� � ��C� � � �� �"�-