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CERTIFICATE OF LIABILITY INSURANCE (763)ADO fl CERTIFICATE OF LIABILITY INSURANCE TAMPBAY -04 BWARNER I DATE (MM /DD/YYYY) 7/26/2016 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 ASSOCIATES AGENCY, INC. 11470 N 53rd St Temple Terrace, FL 33617 INSURED CONTACT NAME: PHONE (A/C. No. Ext): (813) 988 -1234 E-MAIL RSS: certs @associates ins.com FAX No): (813) 988 -0989 INSURER(S) AFFORDING COVERAGE INSURER A : Admiral Insurance Co. Tampa Bay Fire Protection, Inc 10977 49Th St North STE 4 Clearwater, FL 33762 COVERAGES INSURER B : OWNERS INSURANCE CO. NAIC # 24856 32700 INSURER C:Admiral Insurance Co. 24856 INSURER D: American Interstate Insurance Co 31895 INSURER E : Southern Owners Insurance Co 10190 INSURER F : 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 POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR SUBR LTR WVD ADDL INSD TYPE OF INSURANCE A B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR POLICY NUMBER GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- JECT LOC OTHER: AUTOMOBILE LIABILITY x X C D E X ANY AUTO ALL OWNED AUTOS HIRED AUTOS UMBRELLA LIAB EXCESS LIAB CA000024988 -01 POLICY EFF (MM /DD/YYYY) 07/28/2016 POLICY EXP (MM /DD/YYYY) 07/28/2017 EACH OCCURRENCE LIMITS DAMAGE TO RENTED PREMISES (Ea occurrence) 1,000,000 $ 100,000 MED EXP (Any one person) 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG 2,000,000 X SCHEDULED AUTOS NON -OWNED AUTOS X 4989280300 06/01/2016 06/01/2017 Profess. Liab. COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 $ 1,000,000 BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) OCCUR CLAIMS -MADE DED 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 Equipment Floater GX000000043 -01 07/28/2016 07/28/2017 EACH OCCURRENCE AGGREGATE 2,000,000 2,000,000 Y/N N/A AVWCFL2505322016 05/29/2016 05/29/2017 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE 1,000,000 20892821 06/01/2016 06/01/2017 E.L. DISEASE - POLICY LIMIT Rented /Leased Equip DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Robert Nunley Lic. # 59948300012005 CERTIFICATE HOLDER 1,000,000 20,000 CANCELLATION City of Clearwater 100 South Myrtle Avenue 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