CERTIFICATE OF LIABILITY INSURANCE�,�� NORTSTA-01 DDONAHOE
ACORt7; DATE (MM/DD/YYri)
� CERTIFICATE OF LIABILITY INSURANCE 2/19/2015
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 ueMFACT
INSURED
/Assured Neace Lukens Insurance Agency Inc
3oulevard. Suite 100
North Star Destination Strategies, Inc
209 Danyacrest Drive
Nashville, TN 37214
15)301-2500
INSURER(S) AFFORDING COVERAGE
�r,suReRn:Cincinnati Insurance Company
iNSUReR e: Cincinnati Indemnity Company
iNSUReRC:AXIS Insurance Company
INSURER D :
INSURER F :
301-2597
NAIC #
10677
3
COVERAGES CERTIFICATE NUMBER: 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 POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE POLICY NUMBER MM/DDIYYYY MMIDDIYYYY
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 'I �OOO,OOO
CLAIMS-MADE � oCCUR ECP 0289555 11/72/2014 11I1212015 pREMISES Ea occurrence S 1,000,000
MED EXP (Any one person) $ � 0,�0�
PERSONAL &ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ Z,OOO,OOO
POLICY � PR� � LOC PRODUCTS-COMP/OPAGG $ Z,OOO,OOO
JECT
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 'I,OOO,OOO
Ea accident
A ANY AUTO ECP 0289555 11112I2074 11/12/2015 BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
X AUTOS X NON-0WNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Per accident
$
UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ ��OOO�OOO
A EXCESSLIAB CLAIMS-MADE ECP 0289555 11/72/2014 11112/2015 qGGREGATE $
DED RETENTION$ $ 'I,OOO,OOO
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS' LIABILITY STATUTE ER
B ANY PROPRIETOR/PARTNER/EXECUTIVE Y 1 N EWC 029�922 11112I2014 1111212015 E.L. EACH ACCIDENT $ �,��0,���
OFFICER/MEMBER EXCLUDED? � N � A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ �,��0,000
If yes, describe under
DESCRIPTION OF OPERATIONS bClOw E.L. DISEASE - POLICY LIMIT $ 'I,OOO,OOO
C Professional Liabili MCN000036991401 07/24/2014 07/2412015 Each Wrongful Act 1,000,000
C Professional Liab MCN000036991401 07/24/2014 07/24/2015 Total Limit of Ins 2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER
City of Clearwater
712 S Osceola Avenue
Clearwater, FL 33758
ACORD 25 (2014/01)
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
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