CERTIFICATE OF LIABILITY INSURANCE (939) O DORSOL-01 DSTEWART
�M
CERTIFICATE OF LIABILITY INSURANCE D110/2612018
ATE(MMIDDIYYYY)
4•••- 1 0/2612 01 8
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).
CONTACT Dixie Lee Stewart
PRODUCER NAME,
Underwood Anderson 8 Assoc.,Inc.
2302 North 9th Ave (A/C PHONE,Ext):($60)434-5626 1FAr�c,No):($50)438-0330
Pensacola,FL 32503
E-MAIL
.dixie@underwoodanderson.com
INSURERS AFFORDING COVERAGE NAIL
INSURER A:Westchester Surplus
INSURED INSURER B.ACE Property&Casual Insurance Company 20699
Odorzation Solutions,Inc INSURER C:
8504 Jade Acres Rd INSURER D:
Pensacola,FL 32526
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 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.
iNSR ADDL SUBR POLICY EFF POLICY EXP
LTRTYPE OF INSURANCE IN yyVp POLICY NUMBER MM1DD MMf D LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000
CLAIMS MADEOCCUR X X G24096567010 1012912018 10129/2019 PIMAAGE TO REw1
NTED $ 50,000
. _..
X Contractor's Polluti MED EXP(Any oneperson) $ 5,000
PERSONAL&ADV INJURY $ r 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY JEOOT 0 LOC PRODUCTS-COMPIOPAGG S 2,000,000
OTHER: POLLUTION $ 1,000,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5,000,000
$
X ANY AUTO X X H08450511010 10129/2018 1012912019 BODILY INJURY Per rsonl) $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY Per accident
ZVOS ONLY ALTOS ONTY PeaacEciRde,DAMAGE S
PIP $ 10,000
A UMBRELLA LIAB OCCUR EACH OCCURRENCE S 2,000,000
X EXCESS LIAB CLAIMS-MADE 624096579010 10129/2018 1012912019 AGGREGATE $ 2,000,000
DED=RETENTION$ Prod/Comp.Ops $ 2,000,.000
WORKERS RTU OTIr-
AND EMPLOYERS'LIABILITY Y I N
ANY PROPRIETORIPARTNERIEXECURVE ❑ E.L.EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED? NIA'
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.QtSEASE-POLICY UMIT $
A Pollution Liability G24096667010 10/29/2018 10/2912019 Each Claim 1,000,000
A Pollution Liability 624096667010 10129/2018 10129/2019 Aggregate 1,000,000
DESCRIPTION OF OPERATIONS f LOCATIONS 1 VEHICLES (ACORD 191,Additional Remarks Schedule,may be attached tr more space is aired)
City of Clearwater is an Additional Insured on a primary and non-contributory basis as pertains to General Lia ility as required by written contract.City of
Clearwater is an Additional insured as pertains to Auto Liability as required by written contract.Waiver of Subrogation applies to General Liability and Auto
Liability as required by written contract Excess Liability over General Liability onlylfollowing form.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Ci of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City ACCORDANCE WITH THE POLICY PROVISIONS.
P.O.Box 4748
Clearwater,FL 33756
AUTHORIZED REPRESENTATIVE
ACORD 25(2016103) Q 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD