CERTIFICATE OF LIABILITY INSURANCE (488) ACCOREP CERTIFICATE OF LIABILITY INSURANCE DATE
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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(les)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 Wallace,Welch$ Willingham PNHME: T CertificateslCommercial Lines ONE FAx
P.O.Box 33020 •727-522-7777 � AfC No):727-521-2902
St. PetersburgFL 33733 MAIL
,..DRESS: certlticates W3ins.com
INSURE SAFFORDINGCOVERAGE NAIL9
INSURER A:Brid efield Em to ers Ins.Co. 107131
INSURED CUMar-1
Cambay&Fair Inc INSURER 8:Continental Casualty Co,1C NA _.. 20443
2463 Enterprise Rd INSURER C:Nat'l Fire Ins Co of Hartford 20478
Clearwater FL 33763 INSURER D:Continental Insurance Company/CNA 35280
INSURER E;Ar onaut Insurance Company 19801
INSURER F:
COVERAGES CERTIFICATE NUMBER:603130126 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
T POLICY NUMBER MM 00/1111 011 YYY LIMITS
6 X COMMERCIAL GENERAL LIABILITY 2086949437 311612019 311612020 EACHOCCURRENCE $1,OOo,Doo
CLAIMS-MADE I OCCUR �� �I
PREMISES Ee rocurrance} $100,000
{ M.ED EXP(Any one person) $5,000
P RSONAL&ADV INJURY $1,000,000
GEN L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
_ POLICYXRO-
❑JPECT El LOC PRODUCTS-COMPIOPAGG $2,OOO.DOO
OTHER: $
C AUTOMOBILE LIABILITY2088208783 311612019 3/1612020 COMBINED ISINGLE LIMIT $1,o00,000
IX
ANY AUTOBODILY€NJURY(Per person) $
OWNED SCHEDULEDBODILY€NJURY Par a.Ccidant $AUTOS ONLY AUTOS ( )HIRED X NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY Per 0 $'
$
0 X UMBRELLALIAS X. OCCUR 02086949471 311612019 311512020 EACH OCCURRENCE $2,000,000
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DED X RETENTION$In nnn $
A WORKERS AND EMPLOYERS LIABILITY Y t N 83064388 3,d1 fi12019 31t6T2o20 X STA UTE R"
ANYPROPRIETORIPARTNER(EXECUTIVE E.L.EACH ACCIDENT $1.000,000
(
(Mandatory In NH)RIMEnIBEREXCLUDED? NIA E.L.DISEASE=EA EMPLOYEE $1,000„000
'(I4aaada
If yes,dascnbe under
DESCRIPTION OF OPERATIONS taelow E.L.DISEASE-POLICY LIMIT $1,000,000
E Professional Laky 121AE000350500 311612019 3/1612020 Each cialm $2,000,000
Clalmr,Made. A $2,00{1,1100
Retro Daae 2119/2016 Daduollbie $25,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required]
City of Clearwater is Additional Insured on a primary and non contributory basis with respect to General Liability subject to terms,Conditions and exclusions of
the policy form.City of Clearwater is Additional Insured With respect to Auto Liability per Auto Coverage Form and on the Excess Policy subject to the
underlying policy terms and conditions. A Waiver of Subrogation in favor of City of Clearwater applies to General Liability,Auto Liability and Workers
Compensation if required 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 ClearwaterACCORDANCE'WITH THE POLICY PROVISIONS.
Engineering, RFO#34-15
P.O.Box 4746 AUTHORIZED REPRESENTATIVE
Clearwater FL 33758-4748
CQ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 26(2016€03) The ACORD name and logo are registered marks of ACORD