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CERTIFICATE OF LIABILITY INSURANCE (784)ACRD CERTIFICATE OF LIABILITY INSURANCE D DATE(MM/DD/YYYY) 08/17/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. T THIS 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 C CONTACT J MICHAEL WELCH NAME: PHONE (941) ADDRESS: INSURERS) AFFORDING COVERAGE N NAIC # INSURERA: SOUTHERN - OWNERS INSURANCE COMPANY 1 10190 INSURED I INSURER B : OWNERS INSURANCE COMPANY 3 32700 INSURER C: $ 10,000 $ 1,000,000 $ 2,000,000 INSURER D : AGGREGATE LIMIT APPLIES PER: POLICY 0 JE a 0 LOC OTHER: INSURER E : $ 2,000,000 INSURER F : $ • ___ '''.._" RC YIJIVI7 nYV1YIDem: 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 AUUL. INSD X bUtK WVD X POUCY NUMBER 20255996 POUCY EFF (MM/DD/YYYY) 08/19/2016 POUCY EXP (MM/DD/YYYY) 08/19/2017 UMITS • A X GEN'L IIC jI COMMERCIAL GENERAL UABIUTY ACLAIMS -MADE UI OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE I O RC N rED PREMISES (Ea occurrence) $ 300,000 MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE $ 10,000 $ 1,000,000 $ 2,000,000 AGGREGATE LIMIT APPLIES PER: POLICY 0 JE a 0 LOC OTHER: PRODUCTS - COMP /OP AGG $ 2,000,000 $ B AUTOMOBILE UABIUTY X X 48- 459330 -01 08/19/2016 08/19/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ANY AUTO AUT03NED x HIRED AUTOS ■ AUTOSULED AUTOS BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A �( UMBRELLA LIAB EXCESS UAB X OCCUR CLAIMS -MADE 48- 459330 -00 08/19/2016 08/19/2017 EACH OCCURRENCE S 2,000,000 AGGREGATE S 2,000,000 $ DED I O RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' UABIUTY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A f II STATUTE I II ETµ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) RECEIVED AUG 2 3 2016 OFFICIAL RECORDS AND LEGISLATIVE SRVCS DEPT CANCELLATION CITY OF CLEARWATER 100 SOUTH MYRTLE AVENUE, 2ND FLOOR 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 ACORb CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD