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CERTIFICATE OF LIABILITY INSURANCE (6) DATE(MM/DD/YYYY) A CERTIFICATE OF LIABILITY INSURANCE 10/28/2016 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 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 2 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT AOn Risk services South, Inc. _NAME: PHONE FAX L Atlanta GA Office (A/C.No.Ext): C866) 283-7122 A/C.No.: (800) 363-0105 0 3565 Piedmont Rd NE,Blgl,#700 E-MAIL p Atlanta GA 30305 USA ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A, Greenwich Insurance Company 22322 Coca-Cola Beveraqes Florida, LLC INSURER B: XL Insurance America Inc 24554 10117 Princess Palm Avenue suite 400 INSURER C: XL Specialty Insurance co 37885 Tampa FL 33610 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570064260532 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 POLICY EFF POLICY EAP AUU INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY RGE EACH OCCURRENCE $750,000 CLAIMS-MADE X❑OCCUR SIR applies per policy terns & condi ions $100,000 PREMISES Ea occurrence MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $750,000 M GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $1,750,000 S X POLICY �PEO ❑LOC PRODUCTS-COMP/OP AGG $1,750,000 0 OTHER: 0 I- A RAD9437817 10/29/201610/29/2017 COMBINED SINGLE LIMIT n AUTOMOBILE LIABILITY $2,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) Z OWNED SCHEDULED BODILY INJURY(Per accident) N AUTOS ONLY AUTOS HIREDAUTOS NON-OWNED PROPERTY DAMAGE R ONLY AUTOS ONLY Per accident)w N C X UMBRELLA LAB X OCCUR Us00071476L116A 10/29/2016 10/29/2017 EACH OCCURRENCE $5,000,000 V EXCESS LAB CLAIMS-MADE AGGREGATE $5,000,000 DED I X RETENTION$10,000 B WORKERS COMPENSATION AND RWD3001201 10/29/2016 10/29/2017 X PER OTH- EMPLOYERS'LIABILITY Y STATUTE ER 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 $1,000,000— DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) t� city of Clearwater is included as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. Ji;l CERTIFICATE HOLDER 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. city Of Clearwater AUTHORIZED REPRESENTATIVE - 100 South Myrtle Avenue Clearwater FL 33756-5520 USA ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD