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CERTIFICATE OF LIABILITY INSURANCE (741)ALVASYS -01 DWILT '4C.oRON CERTIFICATE OF LIABILITY INSURANCE DAT D/YYYY) 7/15/2016 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 Florida, Inc. 83 N Park Place Blvd Suite #101 Clearwater, FL 33759 CONTACT NAME: PHONE 727 461 -6044 FAX (A/C. No. Ext): ( ) (A/c, No): (727) 4427695 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Owners Insurance Company 32700 INSURED Alva Systems Inc Carlos A Alvarez 10102 Lake Julia Circle Odessa, FL 33556 INSURER B : EACH OCCURRENCE INSURER C : DAMAGE TO RENTED PREMISES�a occurrence) INSURER D X� EPLI: $5,000 INSURER E : $ 10,000 INSURER F : PERSONAL & ADV INJURY COVERAGES 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 TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY EFF POLICY NUMBER (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ' Xi OCCUR 20670349 E, c 07/02/2016 4 ` 07/02/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES�a occurrence) $ 300,000 X� EPLI: $5,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN 'LAGGREG_A_TELIMITAPPLIESPER: POLICY JECT LOC OTHER: $ 1,000,000 GENERAL AGGREGATE PRODUCTS - COMP /OP AGG $ 1,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL AUTOS HIRED AUTOS l- SCHEDULED AUTOS NON-OWNED rr ! 201 V r° ` "J OFFICIAL �^� {� OFFICIAL � f LEGISLATIVE +�� /Cc) b qc AN!---' )$ DEPT COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ F DED j RETENT ON $ $ 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 PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION City of Clearwater P 0 Box 4748 (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 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD