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CERTIFICATE OF LIABILITY INSURANCE (682)ACRD® k11.----- CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 1/28/2016 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 T- -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 I Stahl & Associates Insurance, Inc. 110 Carillon Parkway St. Petersburg FL 33716 CONTACT Sue Russell NAME: (A /C No. E:t�: (727)391 -9791 A%C,No): (727)393 -5623 E-MAIL sue.russell @stahlinsurance.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Amerisure Mutual Ins Co 23396 INSURED Jeffry Knight, Inc. dba Knight Enterprises 6056 Ulmerton Rd Clearwater FL 33760 INSURER B Amerisure Insurance Co 19488 INSURERC:Travelers Property Casualty Co 25674 INSURER D : $ 1,000,000 INSURER E : INSURER F : X COVERAGES CERTIFICATE NUMBER:CL1612830154 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 INSr) SUBR VVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X Kelly Petzold /RUSS GL20128 E t�� PB 0 ` `t' . i' 8/17/2015 AND 8/17/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GE 'L AGGREGATE POLICY OTHER X LIMIT APPLIES PE PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 $ A AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS Comprehensive X _ X SCHEDULED AUTOS NON -OWNED AUTOS Collision rr59"i ! V7. , ,,,' - 0(SV• _ .•, tt", -u��P �GISIA IVE St * c CA2031392J ®� 8/17/2015 8/17/2016 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ PIP -Basic $ 10,000 B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CU2031393 8/17/2015 8/17/2016 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 $ DED X RETENTION$ 0 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N/A WC2006779 1/31/2016 1/31/2017 X PER STATUTE 0TH - ER E.L. EACH ACCIDENT $ 1,000,000 $ 1,000,000 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Inland Marine Contractors Equipment 660322X3409 8/17/2015 8/17/2016 Leased/Rented $100,000 Deductible $5,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) City of Clearwater is included as Additional Insured as required. A 30 day notice of cancellation applies. CERTIFICATE HOLDER CANCELLATION City of Clearwater Attention: City Clerk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 4748 Clearwater, FL 34618 -4748 AUTHORIZED REPRESENTATIVE ___�%% Kelly Petzold /RUSS `�'�EJ� P ACORD 25 (2014/01) INS025 (201401) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD