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DocuSign Envelope ID: BO8E3DDA-6A84-496A-9141-79CF798AEA7B
<br /> DATE(MM/DD/YYYY)
<br /> A�T IJ CERTIFICATE OF LIABILITY INSURANCE 3/3/2016
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT Sandi Ricard, CIC
<br /> NAME:
<br /> Lassiter-Ware PHONE/ o ExtC (800)845-8437 (a//� No): (888)883-8680
<br /> 1300 N. Westshore Blvd. E-MAIL
<br /> ADDRESS:SandiR @lassiter-ware.com
<br /> Suite 110 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Tampa FL 33607 INSURERA:Phoenix Insurance Company 25623
<br /> INSURED INSURERB:Travelers Indemnity Company 25658
<br /> Kessler Consulting, Inc. INSURERC:Travelers Casualty & Surety Co 19038
<br /> 14620 N. Nebraska Avenue INsuRERDAdmiral Insurance Company 24856
<br /> Building D INSURER E:
<br /> Tampa FL 33613 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:16/17-All Lines REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY)
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE TO RENTED ,
<br /> A CLAIMS-MADE X OCCUR 300 000 PREMISES(Ea occurrence) $
<br /> 6806C779035PHX16 3/7/2016 3/7/2017 MED EXP(Any one person) $ 5,000
<br /> PERSONAL&ADVINJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY PRO LOC PRODUCTS-COMP/OPAGG $ 2,000,000
<br /> JECT
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> A X ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BA6C56262116GRP 3/7/2016 3/7/2017 BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS
<br /> NON-OWNED PROPERTY DAMAGE
<br /> X HIRED AUTOS X AUTOS (Per accident) $
<br /> Medical payments $ 5,000
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000
<br /> B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3,000,000
<br /> DED X RETENTION$ 10,000 CUP6C7794891647 3/7/2016 3/7/2017 $
<br /> WORKERS COMPENSATION x 1 PEATUTE 1 ...1 EOTH
<br /> AND EMPLOYERS'LIABILITY Y/N
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N N/A
<br /> C (Mandatory in NH) XAUB4210T58A16 3/7/2016 3/7/2017 E L D I S E A S E E A E M P L O Y E E $ 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $ 1,000,000
<br /> D Professional/Pollution FEIECC1953702 3/7/2016 3/7/2017 EACH OCCURRENCE $2,000,000
<br /> CLAIMS MADE AGGREGATE $2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> For Bidding Purposes Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> C/o Kessler Consulting, Inc. ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 14620 N. Nebraska Avenue
<br /> Building D AUTHORIZED REPRESENTATIVE
<br /> Tampa, FL 33613 ;'
<br /> P Schmaltz/SANDIR --mac`+12-ccslw a,, s„_ n r
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br /> INS025(201401)
<br />
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