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CERTIFICATE OF LIABILITY INSURANCE (3)�e f� ��//'',l/� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6/11/2019 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 JLT S ecialty USA 350 Madison Avenue, 7th Floor New York, NY 10017 www.jltus.com CONTACT Will Johnson PHONE FAX (A/C, No): E-MAILExt): E-MIL ADDRESS: william.johnSOn) jltus.COm INSURER(S)AFFORDING COVERAGE NAIC # INSURERA: American Zurich Insurance Company 40142 INSURED Government Brands Holdings, LLC Bill2Pay, LLC 955A Cobb Place Blvd ' Kennesaw GA 30144 INSURER B: Indian Harbor Insurance Company 36940 INSURER c: Freedom Specialty Insurance Company 22209 INSURER D : Federal Insurance Company 20281 INSURER E : INSURER F : ,/ COVERAGES CERTIFICATE NUMBER: 49214932 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 LTRINSD TYPE OF INSURANCE ADDL SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A / COMMERCIAL GENERAL LIABILITY CPO -7945812-00 6/8/2019 6/20/2020 EACH OCCURRENCE $1,000,000 CLAIMS -MADE ,/ OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $1,000,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L ✓ AGGREGATE POLICY OTHER: LIMIT APPLIES PRO I JECT 1 PER: LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OPAGG $2,000,000 $ A AUTOMOBILE ✓ LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY ✓ SCHEDULED AUTOS NON -OWNED AUTOS ONLY CPO -7945812-00 6/8/2019 6/20/2020 CO accident)cSINGLE LIMIT(Ea $1 000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A `/ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE AUC -7946309-00 6/8/2019 6/20/2020 EACH OCCURRENCE $5,000,000 AGGREGATE $ 5,000,000 DED ✓ RETENTION $10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ B C D Professional/ Cyber Liability Excess Professional Liability Crime MTP9036643 XMF1803589 8251-0648 3/26/2018 6/20/2018 2/21/2018 6/20/2019 6/20/2019 6/20/2019 Limit: $5,000,000; Retention: $50,000 Limit: $5,000,000; Retention: $50,000 Limit:$1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Cityof Clearwater Att: CCustomer Service 100 South Myrtle Avenue Clearwater FL 33756 I 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 A1114?' —1,4' Andre Eichenholtz ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 49214932 I GL Auto Prof Liab Excess 1 Will Johnson 1 6/11/2019 10:50:21 AM (EDT) 1 Page 1 of 1