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CERTIFICATE OF LIABILITY INSURANCE (813) ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/15/2016 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 NAME: Shannon Francois Arthur J. Gallagher Risk Management Services, Inc. A/CC,N EXt:407-563-3520 A/c No:407-370-3057 200 S. Orange Avenue, Suite 1350 E-MAIL Orlando FL 32801 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Safety National Casualty Cor oratio 15105 INSURED CLEARWA-01 INSURER B:LIO des S nd 2987 City of Clearwater INSURER C: Monica Mitchell,Asst. Finance Director INSURER D: P. O. Box 4748 Clearwater FL 33758-5520 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:79083392 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYY MM/DD/YYY B GENERAL LIABILITY N N PK1020916 10/1/2016 10/1/2017 EACH OCCURRENCE $7,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISES S Ea occurrence) $ CLAIMS-MADE F—I OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $14,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ X POLICY PRO ECT LOC Self-insd retention $500,000 J B AUTOMOBILE LIABILITY N N PK1020916 10/1/2016 10/1/2017 Ea accident $7,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident Self-insd retention $500,000 UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ LDED I I RETENTION$ $ A WORKERS COMPENSATION N SP 4055714 10/1/2016 10/1/2017 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE F-1 N/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (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 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) As proof of insurance for the City of Clearwater. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Alvarez New Concepts THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 3617 Hudson Lane ACCORDANCE WITH THE POLICY PROVISIONS. Tampa FL 33618 USA AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD