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CERTIFICATE OF LIABILITY INSURANCE (723)HALECO2 OP ID: SN ACCARL-5® L.,y CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 06/30/2016 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 Brown & Brown of FL , Inc. 3520 Thomasville Rd #500 Tallahassee, FL 32309 Dan Sherraden CONTACT Stacey Nelson PHONE FAX (A/C. No, Ext):850- 656 -3747 (A/C, No): 850- 656 -4065 ADDRESS: snelson @bbtally.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:AmeriSUre Insurance Company 19488 INSURED Hale Contracting, Inc. 1736 Commerce Blvd Midway, FL 32343 INSURER B : Southern Owners 10190 INSURER C 0Y/ 6 20h AND SRVCS DEPT INSURER D : OCCURRENCE INSURER E : INSURER F : CLAIMS -MADE OVERAGES CERTIFICATE NUMBER: 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 INSD SUBR W VD POLICY NUMBER POLICY EFF (MM /DDYYY) /Y POLICY EXP (MM /DD/YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY 78777763 OFFICIAL. LEGISLATIVE iUl RECORDS 0Y/ 6 20h AND SRVCS DEPT 07/01/2017 OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADVINJURY $ 1,000,000 GE 'L AGGREGATE POLICY OTHER: X LIMIT APPLIES JEeT- PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 Emp Ben. $ 1,000,000 B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS ��.�Yi cr�� L 5077776300 07/01/2016 07/01/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1 000 000 > BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 5077776301 07/01/2016 07/01/2017 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ DED X RETENTION $ 0 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED'? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC2097685AIC 07/01/2016 07/01/2017 X I STATUTE I I ER H E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION I City of Clearwater 100 S. Myrtle Ave, Rm 210 Clearwater, FL 33756 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 ACORD 25 (2014/01) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NQTEPi\D INSURED'S NAME Hale Contracting, Inc. HALECO2 PAGE 2 OP ID: SN Date 06/30/2016 The additional insured and /or waiver of subrogation, if shown on this certificate, is added provided this status is required by a written contract, that is executed prior to a loss