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CERTIFICATE OF LIABILITY INSURANCE (968) _ Ben Brown Insurance Agency AC 1 V CERTIFICATE OF LIABILITY INSURANCE °A p71z�`IIn""9 M THIS CERTIFICATE IS ISSUEDAS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POL€CIES 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.pol"Ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terns and conditions of the policy,certain policies may requite an endorsement. A statement an this Certificate does not Confer rights to the certificate holder in Mu of such ardorsernent(s)- PRODUCER CONTACT BeivitCh-CerilfiCates Hen Brown InsuranceAgency PHONE M, [9$1 487-3502 A1C Na: (941)365-3143 3731&Tu tleAve 'MAIL Certirrcates@banbrownins.corn ADUFMSS: INSURER[ AFFORDING COVERAGE HAIL Sarasota FL 34239-6410 ISURERA. United Speciahy Ins Co 12537 INSURED INSURER e: Auto-flmors Insurance Co 18988 J W Harris Contractors,Inc, glguRFR c, Evanston Ins Co 35378 3448 Crystal Springs Rd. INSURER D, Travelers Property Casualty Co ofAmerica 25674 INSURERS; Zephryhllls FL 33540 PISURERF COVERAGES CERTIFICATE NUMBER. 191GL,Exam 1afRA Exs REVISION NUMBER- THIS IS TO CERTIFY THAT THE POLICIES Or INSURANCE LISTED BELOW 14AVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIRGATE MAY BE ISSUES]OR MAY PERTAIN,THE INSURANCEAFI=ORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR TYPE OF INSURANCEAM POLICY NUMBER Mmn MKOO LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000000 DAMAGE 10 RMTE15 CLAIMS-MADE ®OCCUR PREMISES jEa vomwerim S 100,000 MEd EXP(Arty one pecan) $ 5'0130 A Y 1-100017901 06/02/2019 081002020 PERSONAL B Adv INJURY $ 1,000.DDD GEM-AGGREGATE UMITArPPLIES PER, GENERAL AGGREGATE $ 2,006,000 POLICY©JECT EILOC PRVDUCTS-COMfVOPAGG $ 2,000,000 OTHER! 5 AUTOMOBILE LIABILITY COAI6ENED SING LIMIT $ 1,005I,D00 a eocrdant ANYAUTO BODILY INJURY(Par parasol S B OWNED SCHEDULED Y 5142469400 10/3112018 1WO112.019 BODILY INJURY 1Parawidenll S AUTOAUTOS HIRED ONLY NON-OWNED PROPERTY DAMAGE HIRED NON�OWHEO $ AUTOS ONLY AUTO$ONLY F'er ecc2derit PIP 10,000 $ UMBRELLA UAe OCCUR EACH OCCURRPHCE $ 4,O00,t)06 C EXCESS LIAR CLAIMS-MADE MKI.`2EUI-103494 08102/2019 08142/2020 AGGREGATE $ 4,000.004 DED I I RETEM1TItUN S $ WORKERS compa SATION P R TSi- ANO EjWLOYERS'LJABILrrV YIN S-TAM ANY PRC'+PRIETORMARTNERIEXECUTIVE ❑ NIA E.l..EACH ACCIDENT S OFFICE IMEAdA BER EXCLUDED? Icy In HH} E.L DISEASE-EA EMPLOYEE $ it yes,desa ba under OESCRiPTION OF OPERATIONSWc w E.L.DISEASE-POLICY LIMIT S D Excess Liabilfty[Auto on)y) ZUP15T9846A18NF W10112018 10/0112019 Aggregate 9,0510,000 DESCRIPTION OF OPERATEONS I LOCATONSI VEHICLES(ACORD 101,M INIOnal Renum a Schedule,may 4e attached if more"a Is required) MONO Welding and Underground Installation,-Certiftcate holder is included as additional Insured for ongoing and completed operations,on a primary and non-contributory basis,with regard to general liability.Auto liability Includes additional Insured Coverage.All.endorsements are subject to the policy tarns and IimHs. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EHPiRATIOH DATE THEREOF NOTICE WILL BE DELIVERED IN City of Clearwater Administrative Offices and ACCORDANCE WITH THE POLICY PROVISIONS, South Area Servfce Center 400 North Myrtle Ave AUTHORIZED REPRESENTATIVE Clearwater FL 33755 01888.2415 ACORD CORPORATION. All rights reserved. ACORD 25(261 6103) The ACORD name and logo are registered(narks of ACORD