CERTIFICATE OF LIABILITY INSURANCE (16) DATE IMMIDDffYYr
AC R" CERTIFICATE OF LI ILI INSURANCE
08707I2018
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 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:
Hlscox Inc. PHONE (888)202-3007 �_ FAx
t��l�ISla..... MIC,.No):
520 Madison Avenue E-MAIL : contact@hiscox.com
ADDRESS 32nd Floor ..... _ —_.— -
-
NewYOrk,NY 10022 INSURER(SIAFFORDING COVERAGE MAIC#
INSURER A: Hiscox Insurance Company Inc 14200
INSURED INSURER B:
Simms Town and Entertainment INSURER C:
602 Engman St.
INSURER D
Clearwater,FL 33755
INSURER E:
INSURER F
COVERAGES CERTIFICATE NUMBER: 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 I5 SUBJECT TO ALL THE -TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
!NSR TYPE OF IN AD®L POLICY NUMBER MMPDDPOLICYIY
LTR YYY M10DExP MLIMITS
X. I COMMERCIAL GENERAL LIABILITY EAC H OCCU R REN CE $ 1,000,000
I AMAA TiY9 TED
x �
CLAIMS-MADE I OCCUR PREMISES Ea occurrence s 100,000
MED EXP(Ancne person] S 5,000
A Y UDI-2321047-CGL-18 07730/2018 07130/2019 PERSONAL&ADV INJURY s 1,000,000
GEN L.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000
RO-
X POLICY ECT —1 LOC PRODUCTS-COMPJOPAGG -S SIT Gen.,Aid
OTHER: $
AUTOMOBILE LIABILITY .COMBINED SINGLE LIMIT $
(Ea aocldenSl
�'.ANY AUTO BODILY INJURY(Per person) ; S
�.�ALL OWNED SCHEDULED BODILY INJURY(Per accident) $---
_„__w AUTOS A•'I4"IS
NO PROPERTY DAMAGE $
HIRED AUTOS AI.rTOS JPeraccidentl
1
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
f'EXCESS LIAR C;_AMS-MADE AGGREGATE $
_. ,., a.. .._...�.�.,....__
DEO RETENTION S $
WORKERS COMPENSATION
PER OTH-
ERAND EMPLOYERS'LIABILITY YIN STATUTE
ANYPROPRI.ETC RIPARTNERIEXECUT'IVEF—] E.L.EACH ACCIDENT S
O P FIC E R1MEF,4B E R E%C L U D ED7 N]
(Mandatory In NH) E.L.DISEASE.EA E%U LOYEE S
If yes,describe under _
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
I
l
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(ACORD 1€11,Additional Remarks Schedule,may be attached it more apace Is required)
The City of Clearwater is additional insured
CERTIFICATE HOLDER CANCELLATION
The City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
PO Box 4748 Clearwater, FL 33758 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
100
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