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CERTIFICATE OF LIABILITY INSURANCE (774)ACQR'Dg CERTIFICATE OF LIABILITY INSURANCE 4 DATE /201 M /DD/YYYY) 8/4/2016 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 Adcock- Adcock Insurance Agency 315 W. Fletcher Ave. Tampa FL 33612 -3414 CONTACT NAME: Thalia King PHONE Fxt 813- 933 -6691 FAX ( )• (A/C, No): E-MAIL thaliakl�adcock- insurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:SOUthern- OWnerS Insurance Co. 10190 INSURED 1639 Seaberg Builders Inc 5440 Mariner Street Suite 100 Tampa FL 33609 INSURER B :Auto-Owners Insurance Co. 18988 INSURERC:Bridgefield Employers Ins Co 10701 INSURER 0 : $1,000,000 INSURER E : INSURER F : OCCUR COVERAGES 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 LTR TYPE OF INSURANCE ADDL INSD SUER wvo POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 20121122 pppaaa RECEIVED 1 �� AUG v �7� OFFICIAL 8/20/2016 5 2016 RDS ANA 8/20/2017 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE PREMISES RENTED occurrence) $50,000 GEN'L MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 AGGREGATE POLICY X LIMIT APPLIES JE PER: LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $2,000,000 $ B AUTOMOBILE X _ X _ LIABILITY ANY AUTO AUTOS OWNED HIRED AUTOS SCHEDULED NON -OWNED AUTOS lFfr 9541906400 �( rn ' -i G`t�" `E �lWf fn �-' '" . '" /2017 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) PIP $$10,000 B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 9541906401 8/20/2016 8/20/2017 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 DED X RETENT ON $10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 830 -39819 8/20/2016 8/20/2017 X STATUTE OTH- ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Clearwater 100 S Myrtle Clearwater FL 34616 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