CERTIFICATE OF LIABILITY INSURANCE (503) ' DATE(MMIDDIYYYY)
AC'C R 7 CERTIFICATE OF LIABILITY INSURANCE.
6n1201
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 — - NNAMEE: Certificates/Commercial Lines
Wallace Welch&Willingham, Inc. PRONE _
3130 1st Ave,SC., 5th Floor .IAIC.Na.Extl:727-622-7777 I sa c,No 727-521-2902
E-MAIL
Saint Petersburg FL 33701 ADDREss: certificates c�1r w3 ns.oAm
INSURERISF AFFORDING COVERA „_. _ NAIL N w.
.INSURER A Nat'l Fire Ins Co of Hartford _ 20478
INSURED GEORFYO-01 INSURER B:Atlantic Specialty Insurance CCm any 27164
George F.Young of Florida Inc. .. ._ _.
George F.Young Inc. INSURER C:Continental Casual/ Co,/CNA 24443
299 Dr.Martin Luther King St N INSURER D:Valley Forge Insurance Company/CNA 20508
St Petersburg FL 33701 INSURER E:Continental Insurance Companv/CNA 35285
INSURER F
COVERAGES CERTIFICATE NUMBER.1834701290_ REVISION NUMBER.3
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 - n_. ADDL SUBR -. - POLICY EFF POLICY Exp LIMITS
LTR TYPE OF INSURANCE .. POLICY NUMBER MM1D0NYYY MMIDD1Y1tY'Y
A X COMMERCIAL GENERAL LIABILITY Y. Y6046046081 41112019 411/2020 EACH OCCURRENCE. $1,000,004
CLAIMS-MADE OCCUR PREMISES Ey ocur€nee 5144004
MED EXP(Any one person) s15,000
—
X Cross Liab PER ONALB.ADV INJURY $1,000,000 ._
GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE s2,000,000
POLICY EC
'- T LOC i PRODUCTS-COMPIOP AGG $2'..,000,004
OTHER'
0 AUTOMOBILE LIABILITY Y Y 6046046064 4;1/2019 411!2024 COMBINED SINGLE LIMIT S1,00 0,000
Ea aEcident
IANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BO1DILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED XNON-OWNED PeOr PERTnDAMAGE $
AUTOS ONLY AUTOS ONLY PIP$10,040 Com /cull $1,000 DBd
E X UMBRELLA UAB X OCCUR Y Y 4046241064 41112019 I 4/112024 EACH OCCURRENCE $6,040,000_.
-.
EXCESS LIAB CLAIMS-MADE...... AGGREGATE '...$6,000,000
DED I X RETENTION$ $
D WORKERS COMPENSATION Y 646241226 411/24/5 41112020 XPTATUTE ORH-
AND EMPLOYERS'LIABILITY Y I N
ANYPROPRIETORIPARTNERIEXECUTIVE j� N1A... E.L.EACH ACCMENT $1,000,000
OFFICERIMEMBER EXCLUDED? [_J
IMandatory In.NHI. E.L.DISEASE-EA EMPLOYEE $1,440,000
If yyes descr9tre under .-�.�... ____.� -............ .
DE..SCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT $1,000,000
B Protection.&Indemnity Liab 85JH26405 4/112019 4/1/2020 1,000,GW Claim
C Professional/Pollution Liab Y AEH591914142 10/1512018 10/1512419 Per Aggregate 2,000,000
$2,000,000
DESCRIPTION OF OPERATIONS t LOCATIONS 1 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 if required by written contract.
I
City of Clearwater is additional insured on a primary basis with respect to Auto Liability subject to the terms and conditions and exclusions of the policy 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 Clearwater ACCORDANCE WITH THE POLICY PROVISIONS.
Engineering, RFQ#26-19
P.O. 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
Business Auto Policy
CNA
c i r+ i @ �Si it r ri s sV i }• � r� ca' i�
It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows:
Nairne of Additional Insured lPers�ora Or�r 0nl*at11on
ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED BY WRITTEN CONTRACT OR WRITTEN
AGREEMENT TO NAME AS AN ADDITIONAL INSURED.
1. In conformance with paragraph A.9.c. of Who Is An Insured of Section II - LIABILITY COVERAGE, the
person or organization scheduled above is an insured under this polio.
2. The insurance afforded to the additional insured under this policy will apply on a primary and
non-contributory bas's if you have committed it to be so in a written contract or written agreement
executed prior to the date of the "accident" for which the additional insured seeks coverage under this
policy.
All other terms and conditions of the policy remain unchanged
This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers,
takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective
date {the Endorsement Effective Date) is shown below, and expires concurrently with said policy.
j
Form No;CNA71527XX (10-2012) Policy No:BUA 60 6046064
Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Data:04/01/2019
Endorsement No: 13; Page: 1 of 1 Policy Paye: 83 of 209
Underwriting Company: Valley Forge Insurance Company, 151 N Franklin St, Chicago, IL 60606
Copyright CNA All flights Reserved.
CNA CNA PARAMOUNT
Blanket Additional Insured - Owners, Lessees or
Contractors - with Products-Completed
Operations Coverage Endorsement
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
It is understood and agreed as follows:
1. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by
written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily
injury, property damage or personal and advertising injury caused in whole or in part by your acts or omissions, or
the acts or omissions of those acting on your behalf:
A. in the performance of your ongoing operations subject to such written contract-, or
B. in the performance of your work subject to such written contract, but only with respect to bodily injury or
property damage included in the products-completed operations hazard, and only if-.
1. the written contract requires you to provide the additional insured such coverage; and
2. this coverage part provides such coverage,
III. But if the written contract requires:
A. additional insured coverage under the 11-86 edition, 10-93 edition, or 16-Q1 edition of CG201 0, or under the 10-
01 edition of CG2037; or
B. additional insured coverage with "arising out of language;or
C. additional insured coverage to the greatest extent permissible by law;
then paragraph I.above is deleted in its entirety and replaced by the following:
WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by
written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily
Injury, property damage or personal and advertising injury arising out of your work that is subject to such written
contract,
Ill. Subject always to the terms and conditions of this policy, including the limits of insurance,the Insurer will not provide
such additional insured with:
A. coverage broader than required by the written contract; or
B. a higher limit of insurance than required by the written contract.
IV. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property
damage, or personal and advertising injury arising out of
A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services,
including:
1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings and specifications; and
2. supervisory, inspection, architectural or engineering activities; or
S. any premises or work for which the additional insured is specifically listed as an additional insured on another
endorsement attached to this coverage part.
V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS,the Condition entitled Other Insurance is amended to
add the following,which supersedes any provision to the contrary in this Condition or elsewhere in this coverage
part:
CNA75079XX(10-16) Policy No: 6046046081
Page I of 2 Endorsement No: 8
Nat'l Fire Ins Co of Harv_ford Effective Date: 04/Cl/2019
Insured Name: GEOPGE F. YOUNG OF FL, INC.
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc-with its permission.
CNA CNA PARAMOUNT
Blanket Additional Insured - Owners, Lessees or
Contractors - with Products-Completed
Operations Coverage Endorsement
Primary and Noncontributory Insurance
With respect to other insurance available to the additional insured under which the additional insured is a named
insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a written
contract requires the insurance provided by this policy to be:
1. primary and non-contributing with other insurance available to the additional insured-, or
2. primary and to not seek contribution from any other insurance available to the additional insured.
But except as specified above, this insurance will be excess of all other insurance available to the additional insured.
Vt. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL
LIABILITY CONDITIONS is amended as follows:
The Condition entitled Duties In The Event of Occurrence,Offense, Claim or Suit is amended with the addition of
the following:
Any additional insured pursuant to this endorsement will as soon as practicable:
1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim;
2. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation,
defense, or settlement of the claim; and
3, make available any other insurance, and tender the defense and indemnity of any claim to any other insurer or
self-insurer,whose policy or program applies to a loss that the Insurer covers under this coverage part. However,
if the written contract requires this insurance to be primary and non-contributory, this paragraph 3.does not
apply to insurance on which the additional insured is a named insured.
The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives
written notice of a claim from the additional insured.
VII. Solely with respect to the insurance granted by this endorsement,the section entitled DEFINITIONS,is amended to
add the following definition-.
Written contract means a written contract or written agreement that requires you to make a person or organization an
additional insured on this coverage part, provided the contract or agreement:
A. is currently in effect or becomes effective during the term of this policy-, and
B. was,executed prior to:
1. the bodily injury or property damage-, or
2. the offense that caused the personal and advertising Injury
for which the additional insured seeks coverage..
Any coverage granted by this endorsement shall apply solely to the extent permissible by law.
All other terms and conditions of the Policy remain unchanged.
This endorsement,which forms a part of and is for attachment to the Policy issued by the designated Insurers,takes effect
on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and
expires concurrently with said Policy.
CNA75079)(X (10-16) Policy No: 6046046081
Page 2 of 2 Endorsement No. 8
N a t ' I -, i r e T n s Co of Tiara.f�)r d Effective Date: 04/01/2019
Insured Name: CFORGE P. YOUNG F. F`L, !NC,
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with is permission.