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CERTIFICATE OF LIABILITY INSURANCE (512) 76/27/2019 E(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 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). CONTACT PRODUCER Liberty Mutual Insurance NAME: PO Box 188065 PHONE FAX Fairfield, OH 45018 A/C No Ext): 800-962-7132 A/C No: 800-845-3666 E-MAIL ADDRESS: BusinessService@LibertyMutual.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Ohio Casualty Insurance Company 24074 INSURED INSURER B: Ohio Security Insurance Company 24082 Reuben Clarson Consulting,lnc. 750 94th Ave N Ste 213 INSURERC: Saint Petersburg FL 33702 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 49605277 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/YYY MM/DD/YYY A `/ COMMERCIAL GENERAL LIABILITY ✓ BKO58425458 3/31/2019 3/31/2020 EACH OCCURRENCE $1,000,000 DA CLAIMS-MADE 11/1 OCCUR PREM SES Ea occurrDence $200,000 MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 ✓ POLICY ❑ PRO JECT ❑ LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY CEa OMBINEDSINGLELIMIT $ accident 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 UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION XWS58425458 6/18/2019 6/18/2020 �/ STATUTE EERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVEF—] E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1.000.000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) RFQ#26-19 Certificate Holder is Additional Insured if required by written contract or written agreement subject to General Liability Blanket Additional Insured Provision. CERTIFICATE HOLDER CANCELLATION City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Jillian Pietro ACCORDANCE WITH THE POLICY PROVISIONS. 100 S. Myrtle Ave#220 Clearwater FL 33756 AUTHORIZED REPRESENTATIVE Lauren McCormick ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 49605277 1 58425458 1 19-20 Master Certificate Lauren McCormick 1 6/27/2019 6:12:55 AM (PDT) I Page 1 of 1 0 DATE(MM/DDIYYYY) ACORN CERTIFICATE OF LIABILITY INSURANCE ��- 0612612019 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 ri hts to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Statr"FarM Cathy Shadwick Slate Farm Agency PHONE N,.Extif 727-822-1333 AIC No): 3499 4th Street N E-MAIL ADDRESS: St Petersburg,FL. 33704 INSURERS AFFORDING COVERAGE NAICN INSURER A: State Farm Mutual Automobile Insurance Company 25178 INSURED INSURER 8: Reuben Clarson Consulting INSURER C: 780 94th Ave N.,Suite 102 INSURER D: St.Petersburg,FL. 33702 INSURER E: INSURER F; COVERAGES CERTIFICATE NUMBER: 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. WSR ADDL SUBR .POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMfDDfYYYY MMIDDIYYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO RENTF $ CLAIMS-MADE El OCCUR PREMISES Eaoccurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY 5 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 POLICY❑ PRC ❑ LOC PRODUCTS-COMPIOP AGG 5 PRO- - $ OTHER: COMBINED 51NGLE LIMIT $ AUTOMOBILE LIABILITY A 117-8847-F13-59H 06/13/2019 12/13/2019 Ea a.,d.t ANY AUTOE66-2353-814-56 02/14/2013 08/14/2019 BODILY INJURY(Per person) 5 1,000,000 A OWNED SCHEDULED BODILY INJURY(Per accident) $ 1,000,000 AUTOS ONLY AUTOS HIRED NON-OWNED E66-2353-814-56 08/14/2019 02/14/2020 PROPERTY DAMAGE $ 1,000,000 AUTOS ONLY AUTOS ONLY Per accitlent $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE 5 DEO RETENTION$ '$ WORKERS COMPENSATION STATUTE ERH AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNERtEXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY OMIT 5 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101,Additional Remarks Schedule,may be attached If more apace Is required) REFERENCE:RFQ-#26-19; City of Clearwater is an Additional Insured as respects Auto Liability Only. 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. 100 S.Myrtle Ave.,#220 AUTHORIZE PRESENTATi Clearwater,FL. 33756 Attn:Jillian Prieto V918-2015 8-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered rrAUWs of ACORD 1001486 132849.12 03-16-20115