CERTIFICATE OF LIABILITY INSURANCE (384)Cli�nt#: 584486 LEGGEBRA
AC�RDTM CERTIFICATE OF LIABILITY INSURANCE °A�`�""r°°"""�,
10/21/20 t 5
TNfS CERTIFICATE 151S5L1ED AS A NIATTER pF INFQRMA7iONi ONLY AN� CONFERS NO R�GHTS UPON THE CERTIF'iCAT� HOLQER. TH15
CERTIFICAT� pOES NOT AFFIRMATIVELY OR NEGATNELY AMEND, �XTENp OR ALTER THE COVERAC.�E AFFORdEQ BY TFiE POLICIES
BELOW. THIS CERTIFICATE OF 1NSURANCE DOES NQ7 C�NSTITUTE A CONTRACT BETWEEN THE 1SSUING IN$URER(S), AU�h[ORIZED
REPRESENTATIV� OR PRODUCER, AND TFiE CERTIFICATE HOLDER.
lMPORTANT: If the certitiaate holder is an ADDITIONAL INSURE�, the policy(iea) must be endorsed. Ef SUBRDGAT�ON ]S WAIVE�, subJect to
the terms and conditians of the policy, certain poiicies may require en endorsement. A statement on thls certificate dnes not confer rights to the
certificate holder in Ileu of such endorsement(s).
PRODUCER NAME: S�@Ve L811e
USI tnsurance 5er�ices LLC �.��M �xEy; g�� g74-0'123 tarc, No�: 888-813-0463
530 Preston Avenue e-Mn�� � �-
aoo�ess: usicicertificates@usLbiz
Meriden, GT 06450 ITlSURER(5) AFFORp[NG OOVERAGE NAIC;M
855 874-0123 H
INSURF�
Leggette Brashears & Graham, Inc.
4 Research Dri�e Suite 301
Shelkon, CT D6484
�NSUeEp n: artford Ins Co of the Midwest 37478
�r,sueeR e: Hartford Casualty Insura�ce Com 29424
u,suRes c: Hartford Accident & Indemnity C 22357
iNSUReR n: AIG Speclalty Insurance Company 26883
E;
F:
COVERAC,ES CEfiTIFIGATE NEIMBEfl: REVI510N NUMBER:
THIS IS TO CER�IFY THAT THE PpLECIES QF INSURANCE LISTED BELOW HAVE BEEN I5SUED TO THE INSUREp NAMEQ ABOVE FOR TNE POLICY PER10D
IN6ICATED. NOTWITHSTANDING ANY REQUIREMENT, 7ERiVl OR CONaITIpN qF ANY CONTRACT OR OTHER OOCflMENT WITH RESPECT TO WHICH TNIS
CERTIFICATE MAY B� iSSUEp bR MAY PERTAIN, THE 1�lSURANCE AFFORDED BY THE PpLICIES DE5CRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSlONS AND CONDITIQ�tS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCEI� BY PAID CLAIMS.
�� TYPE OF INSURANCE INSR� WYD POLICY N[1MBER Ir1Nf1DUmY MM7��mY� �����
A GENpHALLlAeILITY 31UI1NZK6256" 11/01/2015,�'41lq71201 EACHOCCURRENCE $� ODOQ�
X� COMMERCIAL GENERAL LIABILITY DAMA� E7 RENTE�
PREMISES Eaaccurtence s1 000 fl00
CL,41M5-MA�E � OCCUR ' � r,., .y ����J �- MED EXP {Any one person $ �� QQQ
x� X��`f II1C�Gi�BC� � ;'��'�__ � W� � �E�SONALSADVINJURY $�,aoa��0�
GEN'L AGGRECATE UMIT APPLIES PER:
POL3CY �� pRa —��� LJC
� _.��5� _
� ! AU7011tDBtLF LIABILITY
�
X: aNV auTo
ALL OWNED '� SCNE�LILE�
AU765 AUTOS
X� HIREDAL1F05 X NON-OWNE�
� AiJTOS
3i UENAX2201
F3 � X uMSrt��tnuaa � occuR � 31XHt1FCd726
EKCESS LIAB � CLAIMS-MA�E
�, DEU .�- X � REI'EP1T]ON $� OOOO ��
G WORKERS COMPENSATION � 31 WENJ0622
AN� EIl4PLOYER3' LIA8ILITY Y f N i
OFFICER�/MEM9ER EJACCLU�E6? ECUTIVE� N 1 A I
I(34lsndetory in FEH1 L 11�
D � PolfutionlProfess
I Liab Ciaims Made
i,
110112015:11/U11201
G£NERALAGCaREGATE
PfIO�LIGTS - CONiPlDP AGG
$
BODILY INJURY (Per person) �
BOQILY IN.IURY (Per 8ccident) $
PROPERTY DAMAG� $
Per aocidant
S
1I��I�O�rJ �I�/O�IZOy� EACHOGCLfRRENGE �$'i
AGGREGATE �$i_
�
�•�01�J y�����•2O� X WCSTATU^ OTN-
� E.L. EACH AGCIDENT $1
E.L. �ISEASE - POLICY LIMIT
COPS3778313 61i 712015 � 05l17/201 S,OOO,OODI5,000,000
reiro date 6/17I1S92 50,000 Deductibfe
DESCRIPTION OF pPERAT1pNS / LpCATfONS 1 YEHICLES (Aqaeh ACORD 101, Additlona[ Remerks 9chedule, It more space Is requlredj
City of CEsarwater is lncluded as an Additional Insured under 1he Generaf Lfal�ility and Auiomobile
Liability policies when required in a written agreement in accordance with pa[icy terms, conditians, and
exclusians for work and acti�ities perfamed by the Named Insured.
�.� ��e.l � -� � � �� (' � �n-�Yr�c:� r�o l � -� o � �
RTEFlCATE HOLpER CANC�LLATION
City of Clearwater SHOIfLD ANY OF THE ABpVE D�SCRIBEP PQLICIES BE CANCELLEO BEFQRE
TH� EXPIRATfON DATE THEREOF, NOTICE WILL BE DELIVEREa fiV
Attn: Er�gineering ACCORaANCE WITH THE PdLICY PROV151pNS.
P.O. Sox 4748
CLEARWATER„ FL 33758-474$ AUTHORIZ�U FiEPRESENTATIYE
acoRn xs (zoia�as� 1 of 1
#5165193231M16596058
� 198&201D ACORE} CQRPOFiATION, All rights reserved.
The ACORD name and logo are registered marks of ACORD
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