CERTIFICATE OF LIABILITY INSURANCE (6)`�'� °m CERTIFICATE OF LIABILITY INSURA,NCE DATE09MM�D�p1/YYYY)
THIS CERTIFICATE IS ISSUEp AS A MATTER OF INFpRMATION ONLY AND CdNFERS NO RIGHTS UPdN iHE CERTIFICATE HOLbER. THIS
CERTIFICATE DOES NO7 AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY TWE POLICIES
BELQW. TWIS CER'1'IFICATE OF INSURANCE DOES NOT CQN$TITUTE A CON7'IiACT BETWEEN TWE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPOR7ANT: If the certiflcate holder is an ADDITIONAL INSURED, the policy(fes) must he endorsed. If SUBROCiATIpN IS WAIVED, subjact to
the terms and conditions of the pollcy, certain policies may require an endorsemant. A statement an thls cartlflcate dces not confer NgMs to the
certificate holder in liau of such endorsement(s1.
,4on Risk Services Southwest, inc.
Houstan rX Office
5555 Sdn Felipe
5uite 1500
HOUStOn rX 77056 USA
INSIIRED
TBE GrDUp, InC. Clydno TBE
380 PARK PLACE 6LVD., $UITE 300
CLEARWATER FL 3�579 USA
E�IPdL
ADDRE55:
wsuREa,a
MSURER S:
1NSURER C:
WSURER D:
MSl1RER E:
INSURER F:
(866) 283-7122 "� (847) 953-5390
-- --- IA/C_ No.1:
INSl1RER�S) AFFQRCING COVERAGE NqIC #
Lexington rnsurance company 19437
New tiampshire Tns Co 23841
Chartis Specialty rnsurance Company 26883
�
m
u�
`m
C
c
m
'o
�
�
O
2
COl�ERAGES CERTIFICATE NUMBER: 570043895913 REVISION NUMBER: -
THIS IS TO CERTIFY THAT THE PQLIGIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TNE POLICY PERIOD
INDICATEp. NOTWITHSTANDING ANY REQIJIREMENT, TERM OR CONDI710N OF ANY CONTRACT pR OTMEFi D�CLIMENT WITH RESPECT TO WhiICH THIS
CERTIFICATE MAY BE ISSUED OR MAY P@RTAIN, TWE INSURANCE AFFORpEp BY THE POLICIES DESCRIBED H�REIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITI�NS OF SUCW POLICIES. LIMITS SHOWN MAY MAVE BEEN REDUCED eY PAID CLAIMS. Llmits shown are as requested
L7R TYPE OF INSURANCE �NSR �p POLICY NUMBE p M LIMITS
� GENERAL W1BILf1'Y PROP i ,
�•I . EACH OCCURRENCE $1,000,000
.�,�'� ...� --
X COMMERCIAL GENERAL LIA9ILITY �� � � S 3OO , OOO
PREMIBES Ee n
CLAIMS-MADE n OCCl1R MED EXP (Any one pprSOn) $Z $� �00
GEN'� qGGREGATE LIMI7 APPLIE3 PER:
� PPLICY n PE a n LOC
AUTOMOBILE LIA8ILITY ^
ANY AUTO
ALL OWNED SCHEDULED
AUTOS B AUTOS
HIREpAUTpS NONAWNED
AUTOS
� X UN�REUALL4B X OCCUR
EXCE58 LIAB CLAIM$-MHpE
OED RETENTION 510,000
WORKERS CON�ENSATION AN�
EM�LOYERS' LIABILITY Y I N
ANV PROPRIETOR I PARTNER! EI�CUTIVE
OFFICEWMEMeER p(CIUDED7 ❑ N � A
(Mandatory In NH)
IF ves. descri6e under
oCY a �r z ��
u�� ��6e1�{. ���°�'�� � ��
CA3582 �,1 i L;, J,t
AUtO 11-12 (St8tB5 AS Per
Prtp�11781566 09/30 201:
PERSONALB ADVINJURY E1,000,
GENER,qL AGGREGATE $2 , 000 ,
PRODUCTS-COMPIOPAGG S2,OD0,
COM01NE0 SINGLE LIMIT $1 � OOO ,
BODILY INJURY ( Par person)
BODILV INJURY (Per acGdent)
PROPERTYOAMAGE
EACH OCCURRENGE
AGGR�GATE
E.L. FACH ACCIDENT
E.L. �ISEASEfA EMpLOYEE
E.L. OISEASE-POLICY LIMIT
35,000,000
� I Arc & Eng EB�o incl. PD11 --•--•---- --•--•---- p99regate $5.000,(
siR applies per po1icy ter s& condi ions szrt 5250,C
PESCRIpTION OF OPERATIONS / LOCATpN$ / VEHICLES (Atmch ACORD 107, Addltlpgl RemgHcs Schedule, If moro spaCa Ia requlred)
City of clearwater is listed as additional insured with respect to the aeneral, Auto and Excess �iability policies. waiver of
subrogation in favor of the additional insured applies to the General, ,4uto and ex[ess �iability policies. This insurance is
primary and non-contributory over any other insurance maintained by certificate holder.
CHRTIFICATE HpLDER
City of Clearwater
attn: City Clerk
PO Box 4748
clearwater F� 33758-4748 u5a.
CANCELLA710N
SHDUTA ANV OF THE ABOVE pEBCRIBE� POLICIES BE GANCELLED BEFORE THE
EXPIRATItlN DATE THEREOF, NOTICE WILL 9E DELNERE� W ACCORDANCE WITH THE
PQLICY PROVISIONS.
AUTHORI�O REPRESENTATNE
�� / / / i /
�1988-207p ACORp CdRAORATION. All Wghts reserved.
ACORD 25 (2010/05) The ACORD name and logo are register�d marks of ACORD
�
rn
�i
g
w
O
Z
�
�
�
m
C�