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CERTIFICATE OF LIABILITY INSURANCE (672)AIC "R�® v CERTIFICATE OF LIABILITY INSURANCE DATE (MM /) 12/16/2015 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 Debbie MacGillivra NAME: Y PHONNo Ext: (863) 688 -5495 (FAX No: (863) 668 -4344 Stahl & Associates Insurance Inc. ADDRESS: debbie. macgi11ivray @stahlinsurance.com 91 Lake Morton Drive P O Box 3608 INSURERS AFFORDING COVERAGE NAIC # INSURER A.-Westchester Surplus Lines Ins Co 10172 Lakeland FL 33802 INSURED INSURER B ACE American Insurance Co 22667 INSURERC:Zenith Insurance Company 13269 Odyssey Manufacturing Co. INSURER D: 1484 Massaro Blvd INSURER E: $ 300,000 x INSURER F: $ 10,000 Tampa FL 33619 COVERAGES CERTIFICATE NUMBER:1 /1/16 Master 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 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 SUBR POLICY NUMBER POLICY EFF MM DD POLICY EXP MM D/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE ❑ OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 x MED EXP (Any one person) $ 10,000 Per Project Applies by X G24092975007 10/1/2015 10/1/2016 Written Contract PERSONAL & ADV INJURY $ 1,000,000 Includes Contractual GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 Liability & XCU Coverages POLICY PRO ❑ LOC JECT PRODUCTS - COMP /OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS H08450377007 10/1/2015 10/1/2016 BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ PIP -Basic $ 10,000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 A EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ G24092987007 10/1/2015 10/1/2016 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N] (Mandatory in NH) NIA 2066828612 1/1/2016 1/1/2017 x PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Pollution /Prof Liability G24092975007 10/1/2015 10/1/2016 Ea Poll Condition /Agg $1,000,000 Poll Ded $10K /Prof $25K Pro Ea Claim Aggregate $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space is required) Certificate holder is additional insured with respect to general liability if required by written contract. Ci r i l,elc I IrIk A I c NU1-LItK (;ANGtLLA I IUN 9173 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn : Purchasing ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 4748 Clearwater, FL 33758 -4748 AUTHORIZED REPRESENTATIVE % Tony Martinez /MACG fYrr ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)