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CERTIFICATE OF LIABILITY INSURANCE (727)OP ID: KG '`�� —'CO CERTIFICATE OF LIABILITY INSURANCE DATE 06 /28 /DD/YYYY) 06/28/2016 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 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 GULF COAST COMMERCIAL INS 815B CYPRESS VILLAGE BLVD. SUN CITY CENTER, FL 33573 JOHN YOHO CONTACT PHON: ONE (A/CC, No, Ext): FAX No): POLICY EFF (MM /DD/YYYY) E -MAIL ADDRESS: PRODUCER CUSTOMER ID #: ROOTE -1 INSURER(S) AFFORDING COVERAGE INSURER A: AUTO OWNERS INSURANCE CO NAIC # 18988 INSURED ROOTER MAN OF TAMPA BAY LLC ID 525028 12879 66TH ST LARGO, FL 33773 INSURER B : SOUTHERN OWNERS INS CO 10190 INSURER C : INSURER D : rE RT i °{�� ,. INSURER E : 08/04/2017 INSURER F : $ OVERAGES CERTIF • 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 WW1 POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD /YYYYL T LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR 20687036 rE RT i °{�� ,. 08/04/2016 b ,, Eby 08/04/2017 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED PREMISES (Ea occurrence ) $ 300,000 � CLAIMS -MADE X MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L GENERAL AGGREGATE $ 2,000,000 AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY I PRO- JECT LOC $ AUTOMOBILE 1---- LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS :JUL U '.; (. a016 OFFICIAL i~J"`,'h DS AND LEGiSLAT1VE SR DEPT f COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ —_ PROPERTY DAMAGE (PER ACCIDENT) $ $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 4692246200 08/04/2016 08/04/2017 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 _ _ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS �, / N N / A WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space is required) ERTIFICATE HOLDER I CI -TYOF CITY OF CLEARWATER 100 S MYRTLE AVE ROOM 210 CLEARWATER, FL 33758 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 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD