CERTIFICATE OF LIABILITY INSURANCE (677),acoRV CERTIFICATE OF LIABILITY INSURANCE
DATE(mm /DD/YYYY)
12/29/2015
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
Lykes Insurance, Inc.
P. O. Box 2879
Tampa FL 33601 -2879
NAME: CT
PHONE 1 - (FAX No
IAIC
E -MAIL
ADDRESS: k I in r
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A:WeSffield Insurance
411
12/31/2016
INSURED TBTRA -1
INSURER B:Bridgefield Employers Ins Co.
10701
INSURER C:St Paul Fire & Marine Ins Co.
Tampa Bay Systems Sales, Inc.
dba Tampa Bay Trane
902 North Himes Ave
INSURER D: a lin Insurance Company, Inc.
1
INSURER E:
PREMISES Ea occurrence
Tampa FL 33609
INSURER F:
$10,000
PERSONAL & ADV INJURY
%+VVCKAb CJ UrK I11-IL:A IIn NUMH1I H Ir14RRr19RQQ PFZV1_CI(lkl kill IMRFD-
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
IN SR
B
WVD
POLICY NUMBER
POLICY EFF
MM /DD/YYYY
POLICY EXP
MM /DD/YYYY
LIMITS
A
GENERAL LIABILITY
CMM0154905
12/31/2015
12/31/2016
EACH OCCURRENCE
$1,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR
PREMISES Ea occurrence
$150,000
MED EXP (Any one person)
$10,000
PERSONAL & ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
POLICY X PRO- LOC
PRODUCTS - COMP /OP AGG
$2,000,000
$
A
AUTOMOBILE
LIABILITY
CMM0154905
12/31/2015
12/31/2016
BINED SINGLE LIMIT
Ea accident
$1,000,000
X
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
$
HIRED AUTOS PXPIP$10,000 NON -OWNED
AUTOS
X
PROPERTY DAMAGE
Per accident
$
$
C
X
UMBRELLA LIAR
X
OCCUR
ZUP15R6693815NF
12/31/2015
12/31/2016
EACH OCCURRENCE
$10,000,000
AGGREGATE
$10,000,000
EXCESS LIAB
CLAIMS -MADE
DED X RETENTION$ 10,000
Prod/Comp Opts
$10,000,000
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR /PARTNER /EXECUTIVE
OFFICER /MEMBER EXCLUDED?
NIA
0830 -52169
1/1/2016
1/1/2017
X WCSTATU- OTH-
JORY LIMITS
E.L. EACH ACCIDENT
$500,000
E.L. DISEASE - EA EMPLOYEE
$500,000
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
I E.L. DISEASE -POLICY LIMIT
$500,000
D
Profressionai Liability
Claims Made
CPL2038411215
12/31/2015
12/31/2016
Each Loss 2,000,000
General Aggregate 2,000,000
Retro Date 6/2/15
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
City of Clearwater
112 S Osceola Ave
Clearwater FL 33756
ACORD 25 (2010/05)
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
v iaais -zU10 AGORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD