CERTIFICATE OF LIABILITY INSURANCE (5)CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY)
12/22/2015
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 endnrspmant1c1
PRODUCER
BWD Group LLC
45 Executive Drive
Plainview NY 11803
INSURED
Bright House Networks, LLC.
700 Carillon Parkway (Suite 6)
St. Petersburg FL 33716
RISK MANAGEMENT DEPT
...... . ..._.
16-327-2700 FAX 516 327 -2800
.....
i...(N nog ....
skcerts @bwd.us
....................
A National Union Fire Ins Co Plttsbur. 19445
B New Hampshire insurance Com a__ n
........... . y 23841
c_ Travelers Indemnity Company 125658
D Illinois National Insurance Company 123817
...
E:
THIS IS TO CERTIFY THAT THE POLICIES
• "' "` " �"" ' °�
OF INSURANCE
REVISION NUMBER:
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,
LISTED BELOW HAVE BEEN ISSUED TO
TERM OR CONDITION OF ANY CONTRACT
THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
OR
CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES
OTHER DOCUMENT WITH RESPECT TO WHICH THIS
EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED
DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
INSR_. ....._._.. - -..._
_.........._ BY
- -
PAID CLAIMS.
LTR TYPE OF INSURANCE
, POLICY EFF
INSD VYVD POLICY NUMBER MM /DD /YYYY
POIICYEXP -- --
MM /ODlY 1 LIMITS
A X i COMMERCIAL GENERAL LIABILITY
2039199 : 1H12016
1/1/2017 EACH OCCURRENCE $2000000
CLAIMS -MADE X !OCCUR
..DAMAGE TORENTFD _._..... __........._
PREMISES_. (Ea occurrence) $1,000,000 _...
..._ .......... ................
MED EXP (Any one person) j $EXCLUDED
PERSONAL & ADV INJURY $2,000,000
PLlE
APPLIES PER:
x
GENERAL AGGREGATE j $20,000,000
. - .... ..... _._.
POLICY ;PRO-
; JECT LOC
;_.....
..__
_PRODUCTS COMP /OP AGG J $2,000,000
OTHER:
A I
Per Loc/Project Agg $4,000,000
AUTOMOBILE LIABILITY
9734282 111/2016
1/1/2017
X ANY AUTO
_(Eaaccdent) _G� 1 $2,000,000
- ....
ALL OWNED SCHEDULED
SCHEDULED
BODILY INJURY (Per person) $
I _' AUTOS AUTOS
- - -- _ __
BODILY INJURY (Per accident) j $
X HIRED AUTOS ( X- NON -OWNED
AUTOS
1
'PROPERTY DAMAGE
$
'UMBRELLAUA6
(Per acudenl)
$
C X X OCCUR
- --
,ZUP12P7706916NF 1!112016
1!1/2017
1
EXCESS LIAB
EACH OCCURRENCE $5,000,000
......... _ - ......_..__ ........___. 1.........
I CLAIMS -MADE
--- ... __....... ..........
AGGREGATE 000,000
X �''
$5 '
..._. ....... _ ..... _ ._...... _..... .
. DED RETENTION $10,000
B WORKERS COMPENSATION
A AND EMPLOYERS LIABILITY
066830206(AOS /MONO`) 1/1/2016
'
$
1/1/2017 PER 0TH
X STATUTE
YIN
D ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER
066830207(CA) ! 1/1/2016
! 066830205(FL) 1/1/2016
N
1/1/2017 ER
- -- ...........
1/1/2017 E_L
/MEMBER EXCLUDED? ❑N
EXCLUDED?
(Mandatory in NH)
If yes, describe under
/ A
!
! EACH ACCIDENT $1,000,000
-
E L DISEASE EA EMPLOYEE $1,000,000
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT i $1,000,000
I
DESCRIPTION OF OPERATIONS t LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
"Stop Gap Included for Monopolistic States.
3030 N. Rocky Pointe Drive W., Tampa, FL 33607 Certificate holder is included as additional insured as per written contract or agreement.
rtFRTIPI1`ATC Lint nco _
City of Clearwater
P.O. Box 4748
Clearwater FL 33758 -0000
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
± M
v laoo -cu 14 P1l.VKU 6VKYVKAI IVN. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD