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CERTIFICATE OF LIABILITY INSURANCE (773)ACRD CERTIFICATE OF LIABILITY INSURANCE DAT07/28/2016 Y) 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 have ADDITIONAL INSURED provisions or 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 CONTACT Aon Risk Services Central, Inc. NAME: chi cago IL Office PHONE ) (866) 283 -7122 (A/C. No. Ext : FAX No.): (800) 363 -0105 200 East Randolph Chicago IL 60601 USA E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: ACE American Insurance Company 22667 Sears Holdings Corporation dba Sears Home Improvement Products, Inc INSURER B: ACE Fire Underwriters Insurance Co. 20702 Attn: Risk Management E3 -219A 3333 INSURER C: Beverly Road Hoffman Estates IL 60179 USA INSURER D: INSURER E: INSURER F: tsetwonan,c. -- •-..-- . —. - -__ ... .____ -- . — _ . 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. Limits shown are as requested LIMITS VS-114 LTR A TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY I I PRO n LOC JECT I I OTHER: HDOG27833717 If you no longer require this certificate, please mark DELETE and send to acs.chicago ©aon.com or fax A A AUTOMOBILE LIABILITY X x ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY UMBRELLA LIAB EXCESS LIAB SCHEDULED AUTOS NON -OWNED AUTOS ONLY i ISA ISA ISA OCCUR CLAIMS -MADE DED RETENTION POLICY EFF (POLICY EXP 7820 /012 0$/01 /D 2 ) to 800 -36 H0904419A IIIIP/2016 H09044188 08/01/2016 H09044176AUG 09 2Ct'01/2016 OFFICIAL RECORDS AND LEGISLATIVE SRVCS DEPT EACH OCCURRENCE $5,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $5,000,000 MED EXP (Any one person) Excluded PERSONAL & ADV INJURY $5,000,000 GENERAL AGGREGATE $5,000,000 PRODUCTS - COMP /OP AGG $5,000,000 08/01/2017 08/01/2017 08/01/2017 COMBINED SINGLE LIMIT (Ea accident) $5,000,000 BODILY INJURY ( Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) EACH OCCURRENCE AGGREGATE A 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 N/A WCUC48609259 OH, WA, WV WLRC48609247 All Other States 08/01/2016 08/01/2016 08/01/2017 08/01/2017 PER STATUTE OT- ERH E.L. EACH ACCIDENT $2,000,000 E.L. DISEASE -EA EMPLOYEE $2,000,000 E L DISEASE - POLICY LIMIT Holder Identifier : 2267637 Certificate No : 570063221701 $2,000,000 — MN DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 01, Additional Remarks Schedule, may be attached if more space is required) Alfred W. Nyman, Jr. License # cMc1249510, cGc012538, Ccc1329316 located @ 1024 Florida Central Parkway, Longwood, FL 32750. Dell R. Hoyt License #CGC1517994 located @ 1024 Florida Central Parkway, Longwood, FL 32750. CERTIFICATE HOLDER city of Clearwater 100 S. Myrtle Avenue Suite C -110 Clearwater FL 34616 -5520 USA CANCELLATION 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 Y-!.'a12 May,/G si6stL10 Wm R.orG ✓�A ACORD 25 (2016/03) ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Nel AGENCY CUSTOMER ID: 570000034159 LOC #: REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk services Central, Inc. NAMED INSURED sears Holdings Corporation POLICY NUMBER see Certificate Number: 570063221701 CARRIER See Certificate Number: 570063221701 NAIC CODE EFFECTIVE DATE: REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR wVD POLICY NUMBER POLICY EFFECTIVE DATE (MMTDD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS WORKERS COMPENSATION B N/A SCFC48609260 WI 08/01/2016 08/01/2017 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved.