CERTIFICATE OF LIABILITY INSURANCE (6)CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD[YYYY)
12/22/2015
THIS GERTIFIGATE 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 CONTACT
BWD Group LLC .NAME: RISK MANAGEMENT DEPT
...._................
PHONE _.... ....... ._.
45 Executive Drive (Arc,No...E>n) 516 -327 2700 fc.NO) 516-327-... 2800
E- MAIL . _ ....__.___...
Plainview NY 11803 AnnRF .4. nskcerts @bwd.us
INSURED
Bright House Networks, LLC.
700 Carillon Parkway (Suite 6)
St. Petersburg FL 33716
r<crctaj N.r rvrcurnu VuveRAC,t
A National Union Fire Ins Cc Pittsbur
- ...._... _ _....
NAIC
119445
B New Hampshire Insurance Company
-
23841
c Travelers Indemnity Company
25658
...........
D Illinois National Insurance Cam an
.
23817
E:
KtVI51UN 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.
._._....... ...._...... - -- -- - - -_..
_........_._ .. ...._ -ADDL SUBRj -" - .__ _........___ __....... _ .......__..... ....... . _ ...._._........
INSR-
POLICY -EFF POLICYEXP-
LTR E F INSURANCE INSD WVD POLICY NUMBER ! MM /DDIYYYY MM /DD /YY ! LIMITS
ER
X LIABILITY
2039199 1/1/2016
111!2017
CLAIMS-MADE X !OCCUR
EACH OCCURRENCE 1 $2000000
DAMAGE TO RPNTED f- -
I
PREMISES_(Ea occurren e) $1,000,000
_. _ . ..............
I !
MEDEXP (Any one person) ! $EXCLUDED
-- ........ -- ....- ._............ __- _....._... - ...... - - -- - - - -._
PERSONAL 8 ADV INJURY $2.000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
........ - _ .._._. .. _ _
X 'PRO :
.GENERAL AGGREGATE $20,000,000
_ .... _
POLICY JECT - ....._. LOC
COMPIOP AGG
j OTHER:
! !
.PRODUCTS $2,000,000
- -- ..... - - -_... , __.. .. .......... ...... - - - -..
Per Loc/Pro)ect Agg. ! $4,000,000
A AUTOMOBILE LIABILITY
9734282: 1/1/2016
1/1/2017 tv I IN L
(Ea accident ent} $2,000,000
X ANY AUTO
i
- - --
--
!
BODILY INJURY (Per person)
ALL OWNED SCHEDULED
AUTOS AUTOS
- - - -- _..I ... .. ... ....
BODILY INJURY (Per accident)
accident) $
X { HIRED AUTOS )(� NON -OWNED
..: AUTOS
PROPERTY DAMAGE _ ..... _ ..
$
......
Per accident)
:_ ... .._._._...... _. .__I_ ...... .... ......_.....
_..
1 $
C X : UMBRELLA uAB X OCCUR
ZUP12P7706916NF 1/1/2016
1/112017
> - - - --
EXCESS LIAB
EACH OCCURRENCE $5,000,000
— f....__..
CLAIMS-MADE
- -- - -- --- - - - - --
AGGREGATE
DIED X RETENTION $10,000
- ._$5,000,090
B WORKERS COMPENSATION
A 'AND EMPLOYERS' LIABILITY
066830206(AOS /MONO') 1/1/2016
1/1/2017 PER OTH
YIN,
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER /MEMBER EXCLUDED? N
066$30207(CA) 1(1/2016
: ! 066830205(FL) :. 1/1/2016
NIA
1(1 `2017 -X STATUTE ER
1/112017 E L EACH ACCIDENT $1,000,000
(Mandatory in NH)
If yes, describe under !
:
E L DISEASE EA EMPLOYE19 $1,000,000
nESCRIPTION OF OPERATIONS below
_ -
- --
E.L. DISEASE - POLICY LIMIT $1,000,000
i
!
i
I
I
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.
2530 Drew Street, Clearwater, FL 34625 Certificate holder is included as additional insured as per written contract or agreement.
r'F:0nclr1e7c un1 mcm
City of Clearwater
112 South Oscala Ave.
Clearwater FL 34616 -0000
ACORD 25 (2014101)
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
v 1x00 -zU 14 AI,UKU t4UKYOKA [ION. All rights reserved.
The ACORD name and logo are registered marks of ACORD