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CERTIFICATE OF LIABILITY INSURANCE (910) DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 6/17/2018 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 policy(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 CONTACT NAME: Maura Jordan Arthur J. Gallagher Risk Management Services, Inc. P HONE FAX 200 S. Orange Avenue, Suite 1350 A/c No Ext: 407-370-2320 A/C,No): Orlando FL 32801 ADODRESS: Maura_Jordan@ajg.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Safety National Casualty Corporation 15105 INSURED CLEARWA-01 INSURER B: Lloyd's Synd 2987 City of Clearwater Rick Osorio, Risk Manager INSURERC: P. O. Box 4748 INSURER D: Clearwater FL 33758-5520 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2056634791 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYY MM/DD/YYY B X COMMERCIAL GENERAL LIABILITY PK1020917 10/1/2017 10/1/2018 EACH OCCURRENCE $7,000,000 CLAIMS-MADE � OCCUR PREMISES DAMAGE TO PREMISES Ea occurrence) ccurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $14,000,000 POLICY ❑ PRO ❑ JECT LOC PRODUCTS-COMP/OP AGG $ X OTHER: Self-insd retention $500,000 B AUTOMOBILE LIABILITY N N PK1020917 10/1/2017 10/1/2018 COMBINED SINGLE LIMIT $7,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Self-insd retention $500,000 UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION SP4055714 10/1/2017 10/1/2018 )( PEROTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVEF—] E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Limits are excess of Self-Insured Retentions As proof of insurance for the City of Clearwater. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN FL Dept. of Agriculture&Consumer Services ACCORDANCE WITH THE POLICY PROVISIONS. The Conner Building 3125 Conner Blvd., Suite E AUTHORIZED REPRESENTATIVE Tallahassee FL 32399-1650 r' ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD