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CERTIFICATE OF LIABILITY INSURANCE (16)
ACCORL> CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 01/20/2016 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: PHONE Automatic Data Processing Insurance Agency,Inc. A!c No.Ext) �nrc'No}; 1 Adp Boulevard E-MAIL - - ADDRESSINStiREFr Roseland,NJ 07068 "Y AFFORDING COVERAGE NAIC# _. INSURER Hart ford Underwriters Insurance Company 30104 INSURED - - — - FIELDS INC INSURER B. - -- PO BOX 3337 INSURER C: Clearwater,FL 33767 INSURER D, INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 437852 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 POLICY EFF POLICY EXP INSD WVD POLICY NUMBER MM/DDlYYYY MMlDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR AMA REN D PREMISES Ea occurrence) $ MED EXP(Any one person) $ _ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ POLICY D PRO- JECT LOG PRODUCTS-COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS AUTOS PROPERTY DAMAGE $ i I $ Per accident UMBRELLA LIAB OCCUR EACH OCC_URRENCE__ $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION ER _ AND EMPLOYERS'LIABILITY Y/N X STATUTE EORH ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100:000 A OFFICER/MEMBER EXCLUDED? Y N/A N 76WEGGG6663 01/04/2016 01104/2017 - _...._ Mandatory in I E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under nd __. DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 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 City Of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS. P.O.BOX 4748 Clearwater,FL 33758 AUTHORIZED REPRESENTATIVE A©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD