CERTIFICATE OF LIABILITY INSURANCE (2) DATE(MM/DDYYY)
A�" /YCERTIFICATE OF LIABILITY INSURANCE 2/22/2019
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
NAME: Audrey Dellollo
Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX
200 S. Orange Avenue A/c No Ext): .JC,Noy 407-370-3057
E-MSuite 1350 ADDRESS: Audrey_Dellolio@ajg.com
Orlando FL 32801 INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA: United Educators Ins 10020
INSURED FLORCOL-01 INSURER B: Safety National Casualty Corporation 15105
St. Petersburg College
PO Box 13489 INsuRERc: Qualified Self Insurer
St. Petersburg, FL 33733-3489 INSURERD:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:1682107892 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 MM/DD
A X COMMERCIAL GENERAL LIABILITY J0693Q 3/1/2019 3/1/2020 EACH OCCURRENCE $1,000,000
DAMAGE S( RENTED
CLAIMS-MADE OCCUR
PREMISES Ea occurrence)
ccurrence) $
MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,200,000
POLICY❑ PRO ❑
JECT LOC PRODUCTS-COMP/OP AGG $
X
OTHER: $
A AUTOMOBILE LIABILITY J0693Q 3/1/2019 3/1/2020 COMBINED SINGLE LIMIT $1,000,000
Ea accident
X 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
A UMBRELLA LAB X OCCUR J0693Q 3/1/2019 3/1/2020 EACH OCCURRENCE $4,000,000
X EXCESS LAB CLAIMS-MADE AGGREGATE $4,000,000
DED X RETENTION$1 nnn nnn $
B WORKERS COMPENSATION SP4060046 3/1/2019 3/1/2020 X PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTEI ER
ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $2,000,000
OFFICE R/M EMBER EXCLUDED? ❑ N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $2,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $2,000,000
C WORKERS COMPENSATION RMC20190301 3/1/2019 3/1/2020 Self Insured $750,000
AND EMPLOYERS'LIABILITY Retention
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
"General Liability and Auto Liability policies shown above are subject to a self-insured retention of$200,000 per occurrence. Excess Aggregate applies to
Products, Completed Operations, Employee Occupational Disease,Sexual Molestation and Athletic Traumatic Brain Injury."
License to use multiple sites for athletics
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Clearwater
PO Box 4748 AUTHORIZED REPRESENTATIVE
Clearwater FL 33758-4748
; F
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
DATE(MM/DDYYY)
A�" /YCERTIFICATE OF LIABILITY INSURANCE 2/22/2019
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
NAME: Audrey Dellollo
Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX
200 S. Orange Ave A/c No Ext): .JC,No):407-370-3057
E-MSuite 1350 ADDRESS: Audrey_Dellolio@ajg.com
Orlando FL 32801 INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA: Qualified Self Insurer
INSURED INSURER B: Safety National Casualty Corporation 15105
St. Petersburg College
PO Box 13489 INSURERC:
St. Petersburg, FL 33733-3489 INSURERD:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:729232472 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 MM/DD
A X COMMERCIAL GENERAL LIABILITY RMC20190301 3/1/2019 3/1/2020 EACH OCCURRENCE $200,000
�
OCCUR DAMAGE TO
CLAIMS-MADE
PREMISES(E.
occurrence)
ccurrence) $
MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY❑ PRO-
❑
JECT LOC PRODUCTS-COMP/OP AGG $
OTHER: Ea Occurrence Agg $300,000
A AUTOMOBILE LIABILITY RMC20190301 3/1/2019 3/1/2020 COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO BODILY INJURY(Per person) $200,000
X OWNED SCHEDULED BODILY INJURY(Per accident) $300,000
AUTOS ONLY AUTOS
X HIREDX NON-OWNED PROPERTY DAMAGE $Included
AUTOS ONLY AUTOS ONLY Per accident
UMBRELLA LAB OCCUR EACH OCCURRENCE $
EXCESS LAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
B WORKERS COMPENSATION SP4060046 3/1/2019 3/1/2020 X PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $2,000,000
OFFICE R/M EMBER EXCLUDED? ❑ N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $2,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $2,000,000
A WORKERS COMPENSATION RMC20190301 3/1/2019 3/1/2020 Self Insured $750,000
AND EMPLOYERS'LIABILITY Retention
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
GL-Self Insured per Florida Statute 768.28-$200,000 per Person/$300,000 per Occurrence Aggregate.
WC-Statutory Excess of$750,000 Self Insured Retention.
License to use multiple sites for athletics
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Clearwater
PO Box 4748 AUTHORIZED REPRESENTATIVE
Clearwater FL 33758-4748
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD