The URL can be used to link to this page

CERTIFICATE OF LIABILITY INSURANCE (389) DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 4/1/2016 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). CONTACT Weyman Willingham PRODUCER NAME: Wallace, Welch & Willingham FAX PHONE 727-522-7777727-521-2902 (A/C, No): (A/C, No, Ext): P.O. Box 33020 E-MAIL certificates@w3ins.com St. Petersburg FL 33733 ADDRESS: INSURER(S) AFFORDING COVERAGENAIC # Continental Insurance Co./CNA35289 INSURER A : CUM&F-1Nat'l Fire Ins Co of Hartford20478 INSURED INSURER B : Cumbey & Fair Inc Transportation Ins. Co.20494 INSURER C : 2463 Enterprise Rd Admiral Insurance Company INSURER D : Clearwater FL 33763 Bridgefield Employers Ins. Co.10701 INSURER E : INSURER F : 559128960 COVERAGESCERTIFICATE 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. ADDLSUBR POLICY EFFPOLICY EXP INSR TYPE OF INSURANCELIMITS POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LTRINSDWVD A20869494373/16/20163/16/2017 COMMERCIAL GENERAL LIABILITY X 1,000,000 EACH OCCURRENCE$ DAMAGE TO RENTED X 100,000 CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) 5,000 MED EXP (Any one person)$ 1,000,000 PERSONAL & ADV INJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- 2,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT B 3/16/20163/16/2017 $ AUTOMOBILE LIABILITY C2088208783 1,000,000 (Ea accident) X BODILY INJURY (Per person)$ ANY AUTO ALL OWNEDSCHEDULED BODILY INJURY (Per accident)$ AUTOSAUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ CC20869494713/16/20163/16/2017 UMBRELLA LIAB 2,000,000 EACH OCCURRENCE$ OCCUR EXCESS LIAB 2,000,000 CLAIMS-MADEAGGREGATE$ X 0 $ DEDRETENTION$ PEROTH- WORKERS COMPENSATION E8305436803/16/20163/16/2017 XU.S.L.H. STATUTEER AND EMPLOYERS' LIABILITY Y / N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. EACH ACCIDENT$ Y N / A OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 1,000,000 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below D Professional LiabEO000028661014/9/20164/9/2017Each claim$2,000,000 Claims MadeAggregate$2,000,000 Retro Date 2/19/2000Deductible$25,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is additional insured on a primary and noncontributory basis with respect to General Liability if required by written contract. Certificate holder is additional insured with respect to Auto Liability per Auto Coverage Form and on the Excess Policy subject to the underlying policy termsn and conditions. A Waiver of Subrogation in favor of Certificate Holder applies to General Liability & Auto Liability if required by written contract. CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS. City Clerk P.O. Box 4748 AUTHORIZED REPRESENTATIVE Clearwater FL 33758-4748 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01)The ACORD name and logo are registered marks of ACORD