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CERTIFICATE OF LIABILITY INSURANCE (471)® A j U CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 3/13/2018 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 poiicy(ies) must have ADDITIONAL INSURED provisions or 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 Wallace, Welch & Willingham P.O. Box 33020 St. Petersburg FL 33733 CONTACT NAME: Certificates/Commercial Lines PHONE 727 522-7777 FAX (NC. No. Eta No): 727 521-2902 ADDRESS: certificates@w3ins,com INSURER(S) AFFORDING COVERAGE NAIC A INSURER A : Admiral Insurance Company 24856 INSURED CUM&F-1 Cumbey & Fair Inc 2463 Enterprise Rd Clearwater FL 33763 INSURER B : Bridgefield Employers Ins. Co. 10701 INSURER C : CNA Insurance Company Ltd 3/16/2019 INSURER D : $ 1,000,000 INSURER E : INSURER F : X COVERAGES CERTIFICATE NUMBER: 1435421006 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. INSR LTR TYPE OF INSURANCE ADDL INSQ, SUBR WVD POLICY NUMBER POLICY EFF (MDD/YYYY) POLICY EXPMI IMM/DD/YYYY) LIMITS C X COMMERCIAL GENERAL LIABILITY 2086949437 4i RECEIVE "� MAR 19 2018 3/16/2018 3/16/2019 EACH OCCURRENCE $ 1,000,000 CLAIMS MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $100.000 MED EXP (My one person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE POLICY OTHER: X LIMIT APPLIES jE Q PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ C AUTOMOBILE X X LIABILITY ANY AUTO ONLY HIRED AUTOS ONLY X SCHEDULED AUTOS NON -OWNED AUTOS ONLY 2°86941 2°8694143 FIOL RECORDS :WHOM LEGISLATIVEBODILY SRVCS 01020.18 )EPT. 3/16/2019 COMBINED Ea accident) SINGLE LIMIT $1 000.000 INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE C2086949471 3/16/2018 3/16/2019 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ DED X RETENT ON $ 10 n00 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITYY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) Kdescribe under DESCRIPTION OF OPERATIONS below / N Y N / A 83054368 3/16/2018 3/16/2019 PER STATUTE OTH- ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Professional Liab Claims Made Retro Date 2/19/2000 E000002866103 3/162018 3/16/2019 Each claim Aggregate Deductible $2,000,000 $2,000,000 $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 subject to terms, conditions and exclusions of the policy form. Certificate holder is additional insured with respect to Auto Liability per Auto Coverage Form and on the Excess Policy subject to the underlying policy terms and conditions. A Waiver of Subrogation in favor of Certificate Holder applies to General Liability & Auto Liability if required by written contract. CERTIFICATE HOLDER CANCELLATION I City of Clearwater City Clerk P.O. Box 4748 Clearwater FL 33758-4748 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 REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD