CERTIFICATE OF LIABILITY INSURANCE318822
I DATE �MMIDD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 3/1/2016
THIS CERTIFICATE IS ISSUED A8 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(les) must be endorsed. If SUBROGATION IS WAIVED, subJect to
the terms and conditions of the policy, certaln policles may require an endorsement. A atatement on this certlficate does not confer rlghts to the
certificate holder in lieu of such endorsement(s).
PROOUCER NAME: � Cindy Staley
Commercial Lines -(813) 639-3000 PHONE 800 282 3343 Fi°X (877) 302 4034
A!C No Ext :� � A/C No :
Wells Fargo Insurance Services USA, Inc. E-""aa Cind Stale w g
ADDRESS: Y� YGQ% ellsfar o.com
2502 N. Rocky Point Drive, $Ulie 400 INSURER(S) AFFOROtNG COVERAGE NAIC #
Tampa, FL 33607 iNSURER q: Old Republic Insurance Company 24147
INSURED iNSUReR e: XL Specialty Insurance Company 37885
Communications International, Inc.
INSURER C :
4450 US HighwBy 1 iuc�ioco n•
Vero Beach, FL 32967
COVERAGES CERTIFICATE NUMBER: 10204569 REVt310N NUMBER: See below
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.
��� TYPE OF INSURANCE POLICY NUMBER MM%DDmYY MMIDD/YYYY LIMRS
X COMMERCUIL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
q MWZY306664 03/01/2016 03/01/2017
CLAIMS-MADE � OCCUR . PREMISES Ea owurrence S 500,000
MED EXP (Any one person) $ 10,000
PERSONAL &ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: � GENERAL AGGREGATE $ 2,000,000
POLICY � JECT � �OC PRODUCTS -COMP/OP AGG $ 2.000,000
OTHER: $
A AUTOMOBILELIABILITV MWTB306665 03/01/2016 03/01/2017 EaMaBcICeD I GLELIMIT $ i,000,000
x ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $ �
HIRED AUTOS AUTOS Per aaident
$
B x UMBRELIA LIAB X OCCUR U$00069118LI16A 03/01/16 03/01/2017 EACH OCCURRENCE $ 1,000,000
EXCE55 LIAB CLAIMS-MADE AGGREGATE $ 1,000,000
DED RETENTION $ $
A WORKERSCOMPENSATION MWC30666300 03/01/16 �3/�1/17 X PER OTH-
AND EMPLOYERS' LIABILITY Y � N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? � N � A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 1,000,000
If yes, describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additionsl Remarka Sehedule, may be attaehed il more apaee is required)
�y �:� � � y ��������1_�!� �i�
The City of Clearwater
100 Myrtle Avenue, PO Box 4748
Clearwater, Florida 33756
CHaV C�3 � � �_1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELJVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE /'�
c./(Rn�c/��.
/
The ACOR4 name and logo are registsred marks of A!;ORp O 188�-2094 AGO�D �ORPORATIQN. AI! rights resenied.
ACORD 25 (2014/01)