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CERTIFICATE OF LIABILITY INSURANCE (7) Client#: 8811 CLEARWAT3 DATE(MM/DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 1 10/14/2016 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 CONTACT NAME: Bouchard Insurance Inc. PHONE 727 447-6481 FAX 727 449-1267 A/C,No,Ext: (A/C,No): 101 N Starcrest Dr. E-MAIL ADDRESS: cicertsbouchardinsurance.com Clearwater, FL 33765 INSURER(S)AFFORDING COVERAGE NAIC# 727 447-6481 INSURERA: Nautilus Insurance Company 17370 INSURED INSURER B:Scottsdale Insurance Company 41297 Clearwater Marine Aquarium, Inc. INSURERC:Valley Forge Insurance Co 20508 249 Windward Passage INSURER D: Navigators Insurance Company 42307 Clearwater, FL 33767 INSURER E: Owners Insurance Company 132700 INSURER F: Kinsale Insurance Company 138920 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. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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.ADDLSUBR LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y Y NN725807 10/01/2016 10/01/2017 EACH OCCURRENCE $1,000,000 CLAIMS-MADE 4 OCCUR PREMISES(ERENTED $100,000 X BI/PD Ded:1,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 R - F X POLICY JECT LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ BID E AUTOMOBILE LIABILITY Y 4857348300 09/30/2016 09/30/201 Ee acccden SINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident B UMBRELLA LAB X OCCUR Y Y XBS0068510 10/01/2016 10/01/2017 EACH OCCURRENCE $9,000,000 F X EXCESS LAB CLAIMS-MADE Y Y 01000324961 10/01/2016 10/012017 AGGREGATE $9,000,000 DED RETENTION$ $ C WORKERS COMPENSATION Y 6022864338 04/01/2016 04/01/2017 STATUTE EORH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N] N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$1,000,000 D Protection & NY16LIACFT154758 10/01/2016 10/01/201 9,000,000 Indemnity 135JH26583 10/01/2016 10/01/201 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CITY OF CLEARWATER IS ADDITIONAL INSURED ON GENERAL LIABILITY AND AUTO ONLY IF REQUIRED BY WRITTEN CONTRACT AND SUBJECT TO TERMS, CONDITIONS AND LIMITS AS SPECIFIED IN THE POLICY. (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 112 S. OSCEOLA AVE ACCORDANCE WITH THE POLICY PROVISIONS. CLEARWATER, FL 33756 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) 1 of 2 The ACORD name and logo are registered marks of ACORD #S528757/M525498 SHEFI DESCRIPTIONS (Continued from Page 1) 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 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. SAGITTA 25.3(2014/01) 2 of 2 #S528757/M 525498