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CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DDIYYYY) C" CERTIFICATE OF LIABILITY INSURANCE 02/18/2019 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 Jenna La Fond Van Wyk Risk Solutions _NAME: PHONE 616 942-5070 FAX 616.942.8199 2237 Wealthy Street SE (AIC, A/c No Ext: ( ) A/c No Suite 200 ADDRIESS: JennaL@vanwykcorp.com Grand Rapids, MI 49506 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Zurich American Insurance Company 16535 INSURED Workscapes, Inc. INSURER B: Travelers Property Casualty Company of America 25674 3605 NW 115th Avenue Miami, FL 33178 INSURER C: INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 2019-2020 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/YYYY MMIDD/YYYY A COMMERCIAL GENERAL LIABILITY GLO 0213559-03 01/01/2019 01/01/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE ToRENTE CLAIMS-MADE IN/OCCUR PREMISES(E.occur ence) $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 - POLICY PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JE OTHER $ A AUTOMOBILE LIABILITY BAP 0213560-03 01/01/2019 01/01/2020 COMBINED SINGLE LIMIT $ 1,000,000 Es accident J 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 Uninsur Motorist Combir $ 1,000,000 B UMBRELLALIAB OCCUR ZUP-61 M58496-18-NF 01/01/2019 01/01/2020 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ $ A WORKERS COMPENSATION WC 0213558-03 01/01/2019 01/01/2020 PER OTH- AND EMPLOYERS'LIABILITYSTATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 D? � OFFICER/MEMBER EXCLUDEN I A (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) City of Clearwater is listed as additional insured with respects to General and Auto Liability per written contract or agreement. 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. PO Box 4748 Clearwater, FL 33758-4748 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD