CERTIFICATE OF LIABILITY INSURANCE 1:1A1.1:1JMwDD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
1/3/2017
MHOS 4'ERiIFICATE IS ISSUEO AS A MATTER OF INFORMATEO�N ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIC-ArE' HOLDER. THIS
M�TWICATE DOES NOW AFFIRMAIIVELV OR NEGAtIVELY AMEND, EXWEND OR ALTER THE COVERAGE AFFOkDEO BY IHE POLICitEs
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, Ibe policy(ies) must have ADDITIONAL INSURED provisions or be endorsed,
It SUBROGATION ES WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer riqhts to thie certificate holder in lieu of such endorsement(s).
PRODUCER NAME. Val Hendrickson
Cobb Strecker Dunphy& Zimmermann P14ONr PAX
150 South Fifth Street (VG,Na.EML 612 349-2446 WC,No):
E-MAIL vhendrickson0csdz.cOrn
Suit(-, 2800 ADORES$,
Minneapolis MNI 55407 INSURER(S)AFFORDING COVERAGE NAIC
INSURER A:Zurich American Insurance Company 16535
INSURLD B111-TCONI INSURER 13 American Guarantee & L iab Iris Co 26247
1311trnorp Consfruf:tinn Co., Inc. INqURFR C Indian Harbor ln%uranco Company 36940
1055 Ponce De Leon BIvd
Bel$eair Fl. 33756 INSURER D
INSURER E
INSURER P:
COVERAGES CERTIFICATE NUMBER. 1598007039 REVISION NIJIMBM
D 11"n IS TO (:Lk'1 R Y I HAT II VF POLIC1111-S (A IW3URANCE I.-,TFD f3F]OW I 0AVF RFFN Vr35L11 TO CI iL INSURLD IMAMED ABOVE FOR 11 V POI TCY PILMOD
INDICATED, NOTWI TH STANDING ANY R1 QUIR1 MF N-I, TERM OR CONDITION OF ANY CONTRACT OR OTHER DO(--LJMI N1 WHT-1 RFSPECT 70 WHICH N IN
CER-1TF1(-:ATE MAY BE p'-,SUED <JIII MAY [)I RIAIM 1HE INSURANCE AFFORDLD BY THE POLICIES DESU'RIBED HLRI IN IS SHFULCI K) ALL THE TFPM'),
'AA,'H 110111CH5,UMITS SHOWN MAY HAVE BFFN REDUCFID BY PAID CLAIMS
INSR ADDL SUBR
LTR TYPE OF INSURANCE lfdSD'WVD POLI C Y NUMBE POLICY EFr ACY EXP LIMITS
(MMIODtYYYY)1(MMIDWYYYY
11112017 1110.018
A X G0MMFR(`IAI,6FNT"RAL LIABILITY N.00MV, II FACIII 0(,CtWF?LN(A. 1.O00,000
DAMAGE TO RVI4 rT D
(J-AWS-MADI X 00:LJK
PRI VAT SLS(I a of-cwrencei $1°tl 00,000
X MIED FXF'(Ajiy onv;xmson) S1'o J)00
X
FIFRSONM &ADV IN-MRY s 1,000,000
(A.N .A(,GRF GAT F IOM r APPLES PER crLNLRAL AGGREGATE $?000000
llf�llfly X A [OC
OTHFR F,NEL
A AUTOM0131LE LIASILI TV
)MMINED SINGLE L
0, IF denN) $1'(Jorwoo
X ANY AU 10 0 0 D IL Y INJ J 11,Y(PcT puv�(.,p
OWNED Sl:IIFDULLD
A U F05 GAJ 11 Y A�J fus PODHILY INJURY(P(�T acod,�,nt) S
I I,N L D NON OVdNFD
@IkIOPF R1 Y r)AMA(;r $
ANDS ONLY AUT05 ONLY (F4q accident)
X ("fffl!$1.000 Haed Aidn Phys�Druge, $A(-,V
B X UMBRELLA LIAR x AU(578'165503 11112017 LACITOCCURRIFNCIF s20.000,000
FXCEuS LIA13 (,I AIM'- MADE I I I AGGREGATE'
X $
DEC), RLILN110110
Pi R MfT-
�.q WORKERS COMFIFASAI ION WC,008,151402 11V2017 1110A H x �-;TATUTE ER
AND EMPLOYFRIS'IJARBATY YON, I
ANITY PR OPRff-T01Rir'AF!TNf RAf XECU I IVF ILL.FA"A ACCADI NT $J'()(x')'000
(4 1 KA RimtMBER EXCLUDED? N 'N1 I A
(Mandatory in NTT`) F .DISF ASF-FA IMP OYF F� S1,00➢,000
II ab,de-,cribc vwler
1)f RIP I QN OF OPFRATION',bolow f-L INSIF)19F P01I(-,Y11JF,;)!J j $1,000�,000
friar(Aairns Mad&l lo0 occurreorn PEG(1048851 V1001 1 11112018 $2,000,000 Policy Aqg $7,000,00()La Lo,�'c�
A I or RenIed F(pjq)1A(,'V CIPP10520680? 1110017 1111 120'8 $1,000 Dedkfcfibir $250,0W Per Ilem
Property SpfaCificfpqV Uo-'t V4 ,(.X)O DoductibIp $1.113,918
DESCRIP IION OF OPERATIONS'I LOGAI-IONS fVEHICLES (ACOkU 101,Addiflonall Remarks Schedule,array be attached If more space N;required)
BCC #971: Cfty of Clearwater, FL Fire StaiJon#50, 2691 Countryside Mvd, Clearwater, FL 33756
Addifional Inyved Only If required by wtilten contract wfth respect to General Liability: City of
(1oarwater
................ . ....... ...............................
CLIP T IF ICA E F HOLDER CANCIL I-LATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Cay of CiearwaTel THE EXPIRATION DATE THEREOF, (NOTICE WILL BE DELIVERED IN
1(X)S Myrfle Ave., SuAv 220 ACCORDANCE VAT14 THE POLICY PROVISIONS.
Cleatwater FL 33756-0000
AAUT RIZED REPRESENTATIVE
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