CERTIFICATE OF LIABILITY INSURANCE (815)'o � CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDDIYVYY)
12(0112018
THIS CERTIFECATE IS 1SSUED AS A MATTER OF INFORMATION ONLY AND CONFERS Nd RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATfVELY OR N�GATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THI5 GERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S}, AUTHC3RI2ED
REPaESENTATIVE OR PRODUCER, AND 7WE CERTIFICATE HOLDER.
IMPORTANT: If the esrtificate holder is an ADDIitONAL INSURED, the policy(ies) must be endorsed. if SUBROGATIOfV IS WAIVED, subJect to
the terms and conditfons of the polfcy, cerEain palicies may require an endorsement. A statement on this cerliflcate does nat conter rfghts ta the
certificate holder in lieu of such endorsetnent(s).
PRODUCER
Marsh USA, inc.
4dQ0 Comerica Bank Tower
1717 Main Sireet
Dailas,TX 75201-7357
Attn: dallas.carts@marsh.com
CN 102137489-DBS-16-17
INSURED
GarlandlDBS, Inc.
3800 East 91st Slreet
Cleveland, OH 44105
q, ironshore Specialty Ins. Company
e : Travelers indemnity Co
�, Liberty Insurance Undern+tlters I�c.
a: Travaters Property Casualty Gompany o( Amerfca
E: Hartford Fire insurance Company
8917
COVERAGES CERTIFICATE NUMBER: HOU•0o2712167-04 REVISION NUMBER:1
THIS IS TO CERTIFY TFIAT TNE POLICIES OF INSURANCE LISTED BEEOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEftIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMEN7, TERM OR COhfDIT10N OF ANY CONTRACT OR OTHER DOCUhAENT WITH RESPECT TO WHICH TH[S
CERTIFICATE MAY BE ISSUED OR MAY PERTAIM, THE INSURANCE AFFORDED BY THE POL�CIES DESGRIBED HEREIN (S SUBJECT TO pLL THE TERCvf5,
EXCLUSIONS AND CQNDITIONS OF SUCH ROLICIES. LIMiTS SHOWN MAY HAVE BEEN REDUGED BY PAID CLAIMS.
INSR A6DL SUBR POLICY EFF POLIGY EXP LIMITS
LTR TVPE OF INSURANCE POLICY NUMBER MMI�O/YYYY MMlDDlYYY
A X COMMERCIALOENERALLIA9ILIFY OOYB$9501 1Z/O5IZOIG 12/OSYIOV EACHOCCURRENCE S 1,000,000
DAMAGE TO RENTEO
� CLAIM3•MADE � OCCUR PREMISES Ea ocwrren�_ .� 500,QOO
MEO EXP (Any one person) $ 1�,000
X SIR -$1�O,OOD PERSONAL & AOV IPIJURY $ 1,OOO,Q00
GEN't AGGREGATE LIMIT APPIIES PER: GENERAL AGGREGATE $ 2,dOO,OOO
POUCY ��R� � LOC PRODUCTS - COMPIOP AGG $ 2,000,000
JECT
5
OTHER:
8 AUTOM6811E UbBILITY e�o�sczsss�s-iNO-is �2(OS%Z�IC) 121�$/2017 COMBINEDSINGLE LIMIT g 1,000,000
Ea acGdenl , .
X ANY AUTO BO�ILY INJURY (Per persoo) S
ALL 04VNED SCHEDULE� BOOILY INJURY (Per accidenl} ^y
AUTOS AUTOS --�
X X NON•OWNEO Pe�a cdenDAMAGE �
HIREti AUTOS AUTOS �
� UMeRELIAUAe X 1OOOOZI6��-07 1210512016 12l05E2��� EACHOCCUftRENCE S 5,00O,OOD
oCCUR -
X EXCESS LIAB CLAIMS-AAADE AG6REGRTE S S,OOO,OOO
DED RETENTION S
� WORKER3COMPENSATI6N PJUB-SG220236-16 12I05I2Oi6 i�IOSJZO�% %� STRTUTE �ERH
AN� EMPLOYERS' LIA6ILITY y � N
ANY PROPRIETOflIPARTNER/EXECUTIVE ❑ E.L. E0.CH AGCtOENT $ 1,000,000
dFFICERlMEMBER EXCLUDEO? N N! A
�(Mandatory �n MHj E.L. DISEA5E - EA EMPLOYEE 5 1,QOO,ODO
if yes, describe under 1,000,040
DESCRIPTION OF OPERATIONS below E.l. DISEASE • POLICY LIMIT S
E Inland Marine 83 MS W9553 (Oed: 50,OOD) 12/0512016 12/0512017 Installatian �loaler 9(}D,000
£ Inland Marine 83 MS W9553 (Ded: $2,"�0) 12(0512016 12I05/2017 LeasedtRented Equip 100,000
DESCRIPTION OF OPERATIONS! L6CAT16NS! VEHICLES (ACORD 401, Atltlitlonal Remarks Schedule, may he atteched il more� space is requlred�
Certificate Flotder is included as atldilbnal insured where required by wrilten conlracl wilh respect to General liabilily and pnto Liability.
City ot Cleanvater
Attn: Purchasing
PO Box 4748
Cleanvater, FL 33758
ACORD 25 (201A101}
SHOULb ANY OF THE ABOVE DESCRIBEti P�LICIES BE CANC�LLED BEFORE
THE EXPIRATION DATE THEREQF, NOTICf WIL� BE C7ELIVEREQ Ihl
ACCORDANCE WITH THE POUCY PROVISlONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA inc.
Manashi Mukherjae ..�lavinn►.� �-Ltw.�-e�-
O 198$-2014 ACORD CORPORATIdN. Aii ric�hts reserved.
The AC4RD name and logo are registered marks of ACORD