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CERTIFICATE OF LIABILITY INSURANCE (761)Client#: 4415 CREATIVE/ ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 07/22/2016 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 Bouchard Insurance, Inc. 101 N Starcrest Dr. Clearwater, FL 33765 727 447 -6481 INSURED Creative Contractors, Inc. 620 Drew Street Clearwater, FL 33755 -4108 CONTACT NAME: PHONE 727 447 -6481 (A/C, No, EA): FAX (A /C, No): 727 449-1267 E-MAIL ADDRESS: cicerts bouchardinsurance.com INSURER(S) AFFORDING COVERAGE INSURER A :Westfield Insurance Company INSURER B : St Paul Fire & Marine Ins Co INSURER C : FCCI Insurance Co INSURER D : Ohio Casualty Insurance Co INSURER E : NAIC # 24112 24767 10178 24074 INSURER F : 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. OTWITHSTANDING 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 SUBR W !INSR VD POLICY NUMBER POLICY EFF AMM/DD/YYYY) 08/05/2016 POLICY EXP (MM /DD/YYYY) 08/05/2017 LIMITS EACH OCCURRENCE $1,000,000 $500,000 GENERAL X LIABILITY Y COMMERCIAL GENERAL LIABILITY Y CMM1695019 A PREMISESO(EaEocccu RENTED MED EXP (Any one person) $5,000 $1,000,000 CLAIMS -MADE X - OCCUR PERSONAL 8 ADV INJURY GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GENL AGGREGATE POLICY X LIMIT APPLIES PROT - JEC X PER LOC $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS Y Y CMM1695019 08105/2016 08 /05 /20171OaBWdEDISINGLE LIMIT $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 Y Y Y ZUP71M3768316F 08/05/2016 08105/2017 EACH OCCURRENCE $25,000,000 $25,000,000 AGGREGATE $ DED X RETENT ON $10000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y fJ NI N / A - 38999 08/05/2016 08/05/2017 X TORYIIMITS 14.- $500,000 C E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE - POLICY LIMIT $500,000 A D Leased /Rented Eq Excess Umrella Y Y CMM1695019 EC01656935492 08/05/2016 08/31/2016 08/05/2017 $100,000 ded $1,000 08/31/2017 $25,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) NOTICE: Bouchard Insurance is required to comply with the licensing agreement we hold with ACORD. ACORD, in conjunction with the Department of Insurance, creates and enforces the rules and regulations (See Attached Descriptions) NCELLATION CITY OF CLEARWATER PO BOX 4748 CLEARWATER, FL 33758 -0000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AU—THOQRIIZZED REPRESENTATIVE ACORD 25 (2010/05) 1 of 2 #S484915/M484899 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD GINDE DESCRIPTIONS (Continued from Page 1) pertaining to proper use of the Certificate of Liability Insurance form. We are required to mark a Y next to the line of business in which the Additional Insured or Waiver of Subrogation coverage applies. According to ACORD, the Description of Operations section must be limited to describing information necessary to identify the operations, locations and vehicles for which the certificate was issued. Please note the Description of Operations section of the Certificate cannot be used to add additional information except as just described. Marking a Y next to the line of business adequately documents coverage. Equally important, it satisfies the rules and regulations governing the proper use of the Certificate of Liability Insurance form. Certificate is a reflection of the current coverages provided for the insured. Limits and coverages are afforded to the certificate holder only if required by written contract. Coverage is primary as respects to General Liability and non - contributory as subject to the terms, conditions and exclusions of your policy. Excess Umbrella limit is excess of Primary $25,000,000 Umbrella ATTN: BUILDING DEPT SAGITTA 25.3 (2010/05) 2 of 2 #S484915/M484899