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CERTIFICATE OF LIABILITY INSURANCE (4)Attlyeb* CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 6/21/2019 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). PRODUCERy JLT Specialty USA 350 Madison Avenue, 7th Floor New York, NY 10017 WWW.jltUS.COM CONTACT NAME: Will Johnson PHONE FAX (AExt): (A/C, No): E-MAIL ADDRESS: william.johnson@jltus.com INSURERS) AFFORDING COVERAGE NAIC # INSURERA: American Zurich Insurance Company 40142 INSURED Government Brands Holdings, LLC Bi1l2Pay, 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: 49430966 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 SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP I (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 RETED PREMISES (Ea occurrence) $1,000,000 _ MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L ✓ AGGREGATE I POLICY OTHER: LIMIT APPLIES PET PER: LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $ 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 Ea al e,VNGLE LIMIT $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/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N NIA 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 XMF1903589 8251-0648 3/26/2019 6/20/2019 6/20/2019 3/26/2020 6/20/2020 6/20/2020 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 Attn: Customer Service 100 South Myrtle Avenue Clearwater FL 33756 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 [/ !..--44 Andre Eichenholtz ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 49430966 1 GL Auto Prof Liab Excess 1 Will Johnson 1 6/21/2019 2:17:34 PM (EDT) 1 Page 1 of 1