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CERTIFICATE OF LIABILITY INSURANCE (301)OP ID: JT ACORLy CERTIFICATE OF LIABILITY INSURANCE �� DATE 0810 8 /2 0 1 7Y) 08/08/2017 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 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 813- 636 -4000 Hockman Insurance Agency, Inc. 3438 Colwell Avenue Tampa, FL 33614 CONTACT Jason Travis PHONE 813- 636 -4000 I FAX 813- 281 -1086 (A/C, No, Eat): (A/C, No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Phoenix Insurance Co. 25623 INSURED Advanced Systems Engineering, Inc. 13555 Automobile Blvd., #330 Clearwater, FL 33762 INSURER Indemnity Co. 25658 Travelers Casualty & Surety Co INSURER C : � ure tY 31194 INSURER 0 : Liberty Ins. Underwriters, Inc $ 1,000,000 INSURER E : INSURER F : X COVERAGES • • 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 LTA— TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYV1 POLICY EXP (MM /DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY X )( i 660-1C914015 P , ) 08/ 'x/2017 : J 08/17/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) 100,000 $ MED EXP (Any one person) $ 5'000 PERSONAL&ADVINJURY $ 1'000'000 GEN'L AGGREGATE POLICY OTHER: X LIMIT APPLIES PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO OWNED AUTOS ONLY AUTOS ONLY _ X SCHEDULED AUTOS y� p AUUTOS ONLY X X Lr - c'� 660- 1C914015 08/17/2017 08/17/2018 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE X x CUP- 3951T198 08/17/2017 08/17/2018 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X RETENTION $ 10,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE FFICER /MEMBgER EXCLUDED? (mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A x UB- 3951T162 08/17/2017 0/1/ 08/17/2018 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500'000 E . DISEASE - POLICY LIMIT $ 500'000 D Professional Liability AEE101878 -0002 03/10/2017 03/10/2018 Per Claim Ann Agg 2,000,000 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Professional Liability coverage is written on a claims made and reported basis. Certificate holder is listed as an additional insured with respects to General Liability, Auto Liability, Excess Liability policies on a primary and non- contributory basis. Waiver of Subrogation in favor of the additional insured applies to the GL, Auto Liab,Excess Liability, & WC Policy E HOLDER CANCELLATION CITYOFC City Of Clearwater City Clerk PO Box 4748 Clearwater, FL 33758 -4748 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 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD