CERTIFICATE OF LIABILITY INSURANCE (924) Client#: 1156666 79EQUIPCON
DATE(MMIDDIYYYY)
ACORD,. CERTIFICATE OF LIABILITY INSURANCE 1 712412018
THIS CERTIFICATE IS ISSUED AS A HIATTER 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 ROES NDT 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(les)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,sup*t to the terms and conditions of the policy,certain policies may require an endorsement.A statement on
this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s).
PRODUCERCONTA
NAME:CT_G_A Certificate Team
_
McGrlff insurance Services PHONE T7U 471-71 UD � FAX 877-657-1559
AMC -._.
741 W.Lanier Ave.,Suite 100 EMAIL certificatesga@McGriffinsurance.com
ADDRESS:
Fayetteville,GA 30294-GA INSURER{S).AFFORDING COVERAGE NAICfI
770 471-7104 INSURER A:West Awrlean lnsu rance Company 44393
INSURED INSURER B:Ohio Casu"ln:urance Ca Pany 24074
Equipment-Controls Company INSURER C AMreanFIM and CasuallyCa 24066
PO Box 728
INSURER tl
Norcross,GA 30099
€HSURER E;
INSURER r:
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 CONTRACTOR 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.
EXP
7N TYPE or INSURANCE AAPL$WVD UaR PC€LICYNUMBER MIARLICYfYIYY enrrolLionrYi�YYY uMlrs
A X COMMERCIAL GENERAL LIABILITY BKW1958718631 D713012018 0713012019EACH
��OCCURRENCE $1,000,000
CLAIMS-MADE �OCCUR PREhAM1I5E5 EaEoNccT r,en $1,000,000
MEQ EXP(Any Dnaperson) $15,000
PERSONAL&ARV INJURY $1,000,000
GEN'L AGGREGATE Limn APPLIES PER: GENERAL AGGREGATE s2,000,000
X POLICY[L]PEC LOC PRODUCTS-COMPIOP AGG s 2 DUD 40-0
OTHER: s
B AUTOMOBILELIABILITY l BA01958718631 7130120'18 07130/2019(EaamiE LIMrr
COMBINED amdent) 51,004,400
X ANY AUTO
BODILY INJURY(Per person) $
OWNED SCHEOULED BODILY INJURY(Per accident) S
AUTOS ONLY AUTOS
HIRED NON-OWNED k PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Par accidan!)
S
$ X UMBRELLA LIAR [!��OCCUR US01958718631 713012018 07130/201 EACH OCCURRENCE S4,000,000
--1EXCESS LIAB DE AGGREGATE s41000[}Q�0
-DEO I X RETENTIONS14000 s
C WORKERS COMPENSATION XWA1958718931 0713012018 0713012019 X P5 fi EOTH-
AND EMPLOYERS LIABILITY
ANY PROPRIETOPJPARTNERIEXECIJTIVE YIN E.L.EACH ACCIDENT $500,000
OFFICERIMEMEER EXCLUDED7 N 1 A
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE s504 000
If yes.desaibe under
DESCRIPTION OF OPERATIONS below E-L-DISEASE-POLICY LIMIT $500,D00
r
i
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(ACORD 7(77,Additional Remarks Schedule,may ha attached if muse space Is required)
Workers Compensation Officers Excluded:Jaynes E Bell and Janes E Bell Jr.
City of Clearwater is included as additional insured with respects to General Liability(for ongoing
operations)and Auto Liability when required by written contract.Umbrella follows form subject to policy
terms conditions and exclusions.
CERTIFICATE HOLDER CANCELLATION
City Of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Attn:Purchasing Department,ITB#53-15 ACCORDANCE WITH THE POLICY PROVISIONS.
P❑Box 4748
Clearwater,FL 337584748 AUTHORIZED REPRESENTATIVE
. 0 J.--
C�19UB-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016103)l 1 of 1 The ACORD name and logo are registered marks of ACORD
#5206776341M20661443 CALA