CERTIFICATE OF LIABILITY INSURANCEAFRO® CERTIFICATE OF LIABILITY INSURANCE
DATE 4// 1/2014 YY)
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
Aon Risk Insurance Services West, Inc.
Phoenix AZ Office
2555 East Camelback Rd.
Suite 700
Phoenix AZ 85016 USA
CONTACT
NAME'
PHONE (866) 283 -7122 FAX 800- 363 -0105
(A/C. No. EA; (866) No.):
E -MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURED
Insight Public Sector, Inc.
Attn: Rosalind Berkely
6820 South Harl Avenue
Tempe AZ 85283 USA
INSURER A: Berkley National Insurance Company
38911
INSURER B: Sentry Casualty Company
28460
INSURER C: Sentry Ins A Mutual Company
24988
INSURER D: ACE American Insurance Company
22667
INSURER E:
i CLAIMS -MADE X
INSURER F:
DAMAGE TO RENTED
PREMISES (Ea occurrence)
•
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
INSR
LTR
TYPE OF INSURANCE
ADDL
INSD
SUBR
WVD
POLICY NUMBER
POUCY EFF
(MM/DD/YYYY
POLICY EXP
MM/DD/YYYY),
LIMITS
A
- -1
A
X
COMMERCIAL GENERAL LIABILITY
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04/15/201/15/2015
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EACH OCCURRENCE
$1,000,000
i CLAIMS -MADE X
OCCUR
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$1,000,000
MED EXP (Any one person)
$10,000
PERSONAL &ADVINJURY
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY ❑ �ERa ❑ LOC
OTHER:
GENERAL AGGREGATE
$2,000,000
PRODUCTS - COMP /OP AGG
$2,000,000
AUTOMOBILE LIABILITY
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MY
En
2014
t
04/15/2015
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
X
X
X
ANY AUTO
BODILY INJURY ( Per person)
ALL OWNED
AUTOS
HIRED AUTOS
Comp. Ded. $500
—
—
—
X
SCHEDULED
AUTOS
AUTOSS NED
Col . Ded. $1,000
BODILY INJURY (Per accident)
PROPERTY DAMAGE
(Per accident)
A
X
UMBRELLA UAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
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04/15/2014
04/15/2015
EACH OCCURRENCE
$5,000,000
AGGREGATE
$5,000,000
DED
I (RETENTION
C
B
WORKERS C' COMPENSATION AAND Y/N
N / A
900574903
900574904
MA, WI
04/15/2014
04/15/2014
04/15/2015
04/15/2015
X
PER I
00TH
ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
N
E.L. EACH ACCIDENT
S1,000,000
E.L. DISEASE -EA EMPLOYEE
S1,000,000
DESCRIPTION OF OPERATIONS below •
E.L. DISEASE - POLICY LIMIT
$1,000,000
D
E&O -PL- Primary
EONG21653135009
04/15/2014
04/15/2015
Errors&Ommissions
$10,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
The City of Clearwater, City Council shall be included as an Additional Insured under the General Liability and Automobile
Liability policies. A waiver of subrogation is in favor of the Certificate Holder with respect to the General Liability,
Automobile Liability and workers' Compensation policies.
CERTIFICATE HOLDER
CANCELLATION
City of Clearwater
1000 S. Myrtle Ave., 3rd Floor
Clearwater FL 33756 USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POUCY PROVISIONS.
AUTHORIZED REPRESENTATIVE
9a Maz5. Ra9aa: c/El it a. WAX.
Holder Identifier :
570053456950
Certificate No
b
ACORD 25 (2014/01)
01988 -2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD