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CERTIFICATE OF LIABILITY INSURANCE (6) Client#: 8811 CLEARWAT3 DATE(MM/DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 1 11/06/2015 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(s). PRODUCER CONTACT NAME: Bouchard Insurance Inc. PHONE 727 447-6481 FAX 727 449-1267 A/C,No,Ext: (A/C,No): 101 N Starcrest Dr. ADDRESS: cicerts @bouchardinsurance.com Clearwater, FL 33765 INSURER(S)AFFORDING COVERAGE NAIC# 727 447-6481 INSURERA:Scottsdale Insurance Company 41297 INSURED INSURER B:Scottsdale Insurance Company 41297 Clearwater Marine Aquarium, Inc. INSURERC: Kinsale Insurance Company 38920 249 Windward Passage INSURER D:COMP O dons Insurance Co Inc 10834 (� (� Clearwater, FL 33767 INSURER E: Indemnity Ins Co of North Amer j43575 INSURER F:Atlantic Specialty InsuranceCo 127154 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 CONTRACTOR 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.ADDLSUBR LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/YYYY) A GENERAL LIABILITY Y Y CPS2315021 10/01/2015 10/01/2016 EACHOCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(E.occur°nce $100,000 CLAIMS-MADE �OCCUR MED EXP(Any one person) $5,000 X BI/PD Ded:1,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY M PRO- M LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident B UMBRELLA LIAB OCCUR Y Y XBS0056199 10/01/2015 10/01/201 EACH OCCURRENCE s51000,000 C X EXCESS LAB X CLAIMS-MADE Y Y 01000324960 10/01/2015 10/01/2016 AGGREGATE s5,000,000 DED RETENTION$ $ D WORKERS COMPENSATION CWC1000369 04/01/2015 04/01/201 X TyORY LMITS ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N] N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$1,000,000 E Protect&Indem HUN00876008012 10/01/2015 10/01/2016 1,000,000 F Excess Protection 135JH26583 10/01/2015 10/01/2016 9,000,000 &Indemnity DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE; RENTAL SPACE AT HARBORVIEW CENTER, 320 CLEVELAND STREET, CLEARWATER, FLORIDA-CITY OF CLEARWATER IS ADDITIONAL INSURED ON GENERAL LIABILITY ONLY IF REQUIRED BY WRITTEN CONTRACT AND SUBJECT TO TERMS, CONDITIONS AND LIMITS AS SPECIFIED IN THE POLICY. ** Excess Liability Information** (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 112 S. OSCEOLA AVE ACCORDANCE WITH THE POLICY PROVISIONS. CLEARWATER, FL 33756-0000 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S305965/M299528 DIABE DESCRIPTIONS (Continued from Page 1) C 01000324960 Eff Date: 10/01/2015 Exp Date: 10/01/2016 Excess Liability Retention: 0 Excess Liability Each Occ Limit: $4,000,000 Excess Liability Aggregate Limit:$4,000,000 NOTICE: Bouchard Insurance is required to comply with the licensing agreement we hold with ACORD. ACORD, in conjunction with the Department of Insurance, creates and enforces the rules and regulations pertaining to proper use of the Certificate of Liability Insurance form. We are required to mark a Y next to the line of business in which the Additional Insured or Waiver of Subrogation coverage applies.According to ACORD,the Description of Operations section must be limited to describing information necessary to identify the operations, locations and vehicles for which the certificate was issued. Please note the Description of Operations section of the Certificate cannot be used to add additional information except as just described. Marking a Y next to the line of business adequately documents coverage. Equally important, it satisfies the rules and regulations governing the proper use of the Certificate of Liability Insurance form. Certificate is a reflection of the current coverages provided for the insured. Limits and coverages are afforded to the certificate holder only if required by written contract. SAGITTA 25.3(2010/05) 2 of 2 #S305965/M299528