CERTIFICATE OF LIABILITY INSURANCE (855)J3 KL) CERTIFICATE OF LIABILITY INSURANCE
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DATE(MMIDD/YYYY)
08/02/2017
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
HOLDER. THIS
BY THE POLICIES
AUTHORIZED
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
Marsh Sponsored Programs
a division of Marsh USA Inc.
PO Box 14404
Des M ines, IA 5 306.9686
Lee's Summit, MO 64086
CONTACT
NAME:
PHONE 1.877.320.9393 (A/C 515.365.0895
No. Ext): (ac, No):
E-MAIL
ADDRESS: riskmanagement @marshpm.com Vendor ID: 31459
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: Old Republic Insurance Company
24147
INSURED
CSA Service Solutions, LLC
200 NE Missouri Road
Suite 200
INSURER B :
1 i (`'
INSURER C :
EACH OCCURRENCE
INSURER D :
INSURER E :
CLAIMS -MADE OCCUR
INSURER F :
$
•
RC V1o1VIY IYVMD CR;
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTAND ING 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.
INSR
LTR
TYPE OF INSURANCE
ADDL
INSD
SUBR
WVD
POLICY NUMBER r•:.r
POLICY EFF
(}thyppD/yYYY)
POLICY EXP
LIMITS
COMMERCIAL GENERAL LIABILITY
C .'
L,.... , . y
1 i (`'
"�
EACH OCCURRENCE
$
CLAIMS -MADE OCCUR
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$
GEN'L
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
S
AGGREGATE LIMIT APPLIES
POLICY PRO-
JECT
OTHER:
PER:
LOC
GENERAL AGGREGATE
$
PRODUCTS - COMP/OP AGG
$
$
A
AUTOMOBILE
_
%
LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
X
X
AUTOS SCHEDULED
AUTOOWNED
X
L387995 -17
"' ' "'-
09/01/2017
-- - • .
09/01/2018
COMBINED SINGLE LIMIT
(Ea accident)
$ 1000 000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER /EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
Y/ N
N / A
PER
STAT UTE
OTH-
ER
E.L. EACH ACCIDENT
S
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) GPBR: 1BL4 '
Policy provides protection for any & all operations /jobs performed by the named insured where required by written contract. Certificate holder is an Additional Insured where required by written contract.
Waiver of Subrogation included where required by written contract. Insurance is primary and non - contributory.
CANCELLATION
City of Clearwater
112 S Osceola Ave
Clearwater, FL 33756
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 ATIVE
ACORD 25 (2014/01)
®1988 -2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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