CERTIFICATE OF LIABILITY INSURANCE (935) DATE(MM/DD/YYYY)
AC"R" CERTIFICATE OF LIABILITY INSURANCE
10/31/2018
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 Tonia King
NAME:
The James B.Oswald Company HCONN. Ext): (216)367-8787 a/c,No): (216)241-4520
1100 Superior Avenue East E-MAIL TKing@oswaldcompanies.com
ADDRESS:
Suite 1500 INSURER(S)AFFORDING COVERAGE NAIC#
Cleveland OH 44114 INSURERA: Federal Insurance Company 20281
INSURED INSURER B: Pacific Indemnity Company 20346
Baker&Hostetler LLP INSURER C:
Key Tower Partners only INSURER D:
127 Public Square Suite 2000 INSURER E:
Cleveland OH 44114 INSURER F:
COVERAGES CERTIFICATE NUMBER: 18/19 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 MAYBE 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 INSURANCEAUULbUbK POLICY EFF POLICY EXP
LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000
CLAIMS-MADE FX OCCUR PREM SDAMAGES Ea oNcurDrence $ 1,000,000
MED EXP(Any one person) $ 10,000
A 35287560 11/01/2018 11/01/2019 PERSONAL&ADV INJURY $ 1'000'000
HGEWLAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2'000'000
POLICY � PRO FXLOC PRODUCTS-COMP/OPAGG $ Included
JECT OTHER: W/$1 OM total combined $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
Ea accident
ANYAUTO BODILY INJURY(Per person) $
A OWNED SCHEDULED 71382469 11/01/2018 11/01/2019 BODILY INJURY(Pe r accide nt) $
AUTOS ONLY AUTOS
X HIRED �/ NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY X AUTOS ONLY Per accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION X STATUTE EORH
AND EMPLOYERS'LIABI LI TY Y/N 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
B OFFICER/MEMBER EXCLUDED? ❑ N/A 70086451 12/31/2017 12/31/2018
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
The City of Clearwater is listed as Additional Insured as respects its interest with regard to General Liability and Auto Liability as required of the named
insured by written contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS.
Engineering Department
AUTHORIZED REPRESENTATIVE
100 S.Myrtle Ave.
Clearwater FL 33756
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