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CERTIFICATE OF LIABILITY INSURANCE (489)A� oe CERTIFICATE OF LIABILITY INSURANCE DATE(MMID 19 D/YYTY) 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 Wallace, Welch & Willingham P.O. Box 33020 St. Petersburg FL 33733 CONTACT NAMECertificates/Commercial Lines PHONE FAX (A/C. No. Ext): 727-522-7777 727-521-2902 ADDRESS: Certificates@w3ins.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Bridgefield Employers Ins. Co. 10701 INSURED CUM&F-1 Cumbey &Fair Inc 2463 Enterprise Rd Clearwater FL 33763 INSURER B : Continental Casualty Co./CNA 20443 INSURER C : Nat'l Fire Ins Co of Hartford 20478 INSURER D : Continental Insurance Company/CNA 35289 INSURER E : Argonaut Insurance Company 19801 INSURER F : X COVERAGES CERTIFICATE NUMBER: 2146020155 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 LTR TYPE OF INSURANCE ADDL INSD SUER WVD POLICY NUM POLICY EFF M , • • A ) POLICY EXP (MM/DD/YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY 2086949437 CE.9 RECE MAR 18 OFFICIAL RECORDS I EGISL'°'TIvF cRV 2019 AND DEPT, 3/16/2020 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES a occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 GE 'L AGGREGATE POLICY OTHER: X LIMIT APPLIES JECT PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $2,000,000 $ C AUTOMOBILE X X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY X SCHEDULED AUTOS NON -OWNED AUTOS ONLY 2088208783 6/S 3/16/2020$1,000,000 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ D X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE C2086949471 3/16/2019 3/16/2020 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ DED X RETENT ON $ in nrtn $ A WORKERS COMPENSATION EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N/A 83054368 3/16/2019 3/16/2020 X MUTE STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 E Professional Liab Claims Made Retro Date 2/19/2016 121AE000350500 3/16/2019 3/16/2020 Each claim Aggregate Deductible $2,000,000 $2,000,000 $25,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Certificate holder is additional insured on a primary and noncontributory basis with respect to General Liability subject to terms, conditions and exclusions of the policy form. Certificate holder 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 Certificate Holder applies to General Liability & Auto Liability if required by written contract. CERTIFICATE HOLDER CANCELLATION City of Clearwater City Clerk P.O. Box 4748 Clearwater EL 33758-4748 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ,„, , yet ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A� RO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 3/18/2019 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 Wallace, Welch & Willingham P.O. Box 33020 St. Petersburg FL 33733 CONUNAME: CT Certificates/Commercial Lines PHONE FAX (AIC. No. Extji 727-522-7777 (A/C, No): 727-521-2902 ADDRESS: certificates/@w3ins.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Bridgefield Employers Ins. Co. 10701 INSURED CUM&F-1 Cumbey & Fair Inc 2463 Enterprise Rd Clearwater FL 33763 INSURER B : Continental Casualty Co./CNA 20443 INSURER C : Nat'l Fire Ins Co of Hartford 20478 INSURER D : Continental Insurance Company/CNA 35289 INSURER E : Argonaut Insurance Company 19801 INSURER F : CLAIMS -MADE REVISION NUMBER: v 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. VCR1 ir-IVN IC INSR LTR TYPE OF INSURANCE JNSD ADDL SUER WVD - POLICY NVyfEI r Y EFF ' ) POLICY EXP (MM/DD/YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY 2086949437 t MAR212019 (� OFFICIAL RECORDS t Cl.GIS�TI�,iE SRVCS L / 6/2019 ry AND DEPT.$ 3/16/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE POLICY OTHER: X LIMIT APPLIES PER: JECT J LOC PRODUCTS-COMP/OPAGG $2,000,000 C AUTOMOBILE X X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY X _ SCHEDULED AUTOS NON -OWNED AUTOS ONLY 2088208783 3/16/2019 3/16/2020 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ ((PeracEcidenERTY DAMAGE t)$ $ D X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE C2086949471 3/16/2019 3/16/2020 EACH OCCURRENCE $2,000,000 AGGREGATE $ $ DED X RETENT ON $ in nnn A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N ' N / A 83054368 3/16/2019 3/16/2020 X STATUTE OTH- ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 E Professional Liab Claims Made Retro Date 2/19/2016 121AE000350500 3/16/2019 3/16/2020 Each claim Aggregate Deductible $2,000,000 $2,000,000 $25,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Certificate holder is additional insured on a primary and noncontributory basis with respect to General Liability subject to terms, conditions and exclusions of the policy form. Certificate holder 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 Certificate Holder applies to General Liability & Auto Liability if required by written contract. LI/11 City of Clearwater City Clerk P.O. Box 4748 Clearwater FL 33758-4748 ---•------........ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ;, , ACORD 25 (2016/03) -LU-1'J NI.VRU a.VRr VRNI IVI\. . The ACORD name and logo are registered marks of ACORD