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CERTIFICATE OF LIABILITY INSURANCE (698)DATE (MM/DD/YYYI� ACORD CERTIFICATE OF LIABILITY INSURANCE 05/19/2016 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 NAME: A71ey, Rehbaum & Capes Assurance, Inc. a�"o �,727.797.5193 ��a�N,�;727.725.5773 2433 Gul f to Bay Bl vd. A DR'ESS: P. O. BOX 4620 INSURER(S) AFFORDING COVERAGE NAIC # Clearwater, FL 33758 ,r,suReRn: American States Insurance Co INSURED Adagi o One , IflC . INSURER B: 13811 US Hi ghway 19 N INSURER C: Clearwater, FL 33764 INSURERD: INSURER E : I INSURER F : COVERAGES CERTIFICATE NUMBER: 16/17 GL & AUTO 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 WF+I�H THIS CERTIFICHTE 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. �N R TYPE OF INSURANCE POLICY EF POLI Y EXP LIMRS LTR INSR WVD POLICY NUMBER M/DD MlDD GENERAL LIABILITY 2 5CC362019 OG�'I 4I2O� G OB/� 4/ZO17 EACH OCCURRENCE $ 1� OOO � OO X COMMERCIAL GENERA� LIABILITY PREMISES Ea occurrence) $ 1� OOO � OO CLAIMS-MADE � OCCUR MED EXP (My one person) $ IO � OO A - X PERSONAL � ADV INJURY $ 1� OOO � OO GENERAL AGGREGATE $ Z� OOO � OO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ Z� OOO � OO X POLICY PRO- LOC $ JECT AUTOMOBILE LIABILfTY 2 5CC362019 �6�14�20� 6��� 4/20� 7 (Ea accident) $ 1 � ��0 � �� ANY AUTO BODILY INJURY (Per person) $ A . ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X HIREDAUTOS X NON-OWNED q $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION WC STATU- TH- AND EMPLOYERS' LIABILITY Y � N TORY LIMITS ER ANY PROPRIETOA/PARTNER(EXECUTIV E.L. EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? � N!A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS ! VEMICLES (Attach ACORD 101, Additlonal Remarks Sehedule, i} more space is required) � ertificate Holder is Additional Insured for General Liability CERTIFICATE HOLDER CANCELLATION City of Clearwater 100 5. Myrtle Avenue Cl�arwater, FL 33756 ACORD 25 (2010/05) SHOULD ANY OF THE ABOVE DESCRIBED POIICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WIIL BE DELIVERED IN ACCORDANCE WRH THE POLJCY PROVISIONS. AUTHORIZED REPRESENTATIVE I]ames Parenti/DVIV OO 1988-2010 AC The ACORD name and logo are registered marks of ACORD ��� � -�° ' � �� TION. All rights reserved. > r- C � � � � � � �--�\� �/ CS � ��% } / '6 � � �� f � y �� � � � � �