CERTIFICATE OF LIABILITY INSURANCE (845) 77/25/2019
(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).
PRODUCER CONTACT Linda Fontenot
NAME:
A/CNNo Ext: 713-541-7272 A/C No):713-772-5224
Insgroup, Inc. E-MAIL
5151 San Felipe,24th Floor ADDRESS: Ifontenot@insgroup.net
Houston,Texas 77056 INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA: Starr Indemnity&Liability Company 38318
INSURED INSURER B: Indian Harbour Insurance Company 36940
Heath Consultants Incorporated
9030 Monroe Road
INSURERC:
Houston TX 77061 INSURER D 7
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.
INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICY NUMBER MWDD/YYY MWDD/YYY
A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
CLAIMS-MADE F-1-1
OCCUR DAMAGE TO RENTED 1 000 000
PREMISES Ea occurrence $
MED EXP(Any one person) $ 10,000
1000090437191 7/30/2019 7/30/2020 PERSONAL&ADV INJURY $ 2,000,000
GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
POLICY jECT RO-
LOC PRODUCTS-COMP/OPAGG $ 4,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
A Ea accident
X ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED AUTOS ONLY AUTOS 1000198851191 7/30/2019 7/30/2020 BODILY INJURY(Per accident) $
X HIREDX NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS Per accident
A UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 10,000,000
X EXCESS LIAB CLAIMS-MADE 1000095274191 7/30/2019 7/30/2020 AGGREGATE $ 10,000,000
DED RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
B POLLUTION LIABILITY US000856631_119A 7/30/2019 7/30/2020 $10,000,000 Agg
B PROFESSIONAL LIABILITY US000856631_119A 7/30/2019 7/30/2020 $10,000,000 Agg
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
"'See Attached—
CERTIFICATE HOLDER CANCELLATION
City of Clearwater; SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Attn: Purchasing Department ITB THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
#06-19 ACCORDANCE WITH THE POLICY PROVISIONS.
P.O. Box 4748
Clearwater, FL 33758 AUTHORIZED REPRESENTATIVE
Henry Hochman/
@ 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
Additional Remarks Schedule
The General Liability policy includes a blanket additional insured endorsement OG184 0412 and waiver of subrogation endorsement CG2404 0509 policy
contains a special endorsement with the primary and non-contributory wording per endorsement CG2001 0413 to the certificate holder only when there is a
written contract between the named insured and the certificate holder that requires such status. Contractual Liability coverage provided by the policy is standard
and may not cover all liabilities assumed by the named insured under the contract with the certificate holder endorsement CG0001 0413. Policy include a blanket
30 day notice of cancellation endorsement SIIL 100 1014 to the certificate holder only when there is a written contract between the named insured and the
certificate holder that requires such status.The Auto Liability policy provide a blanket additional insured endorsement SICA1016 0414 waiver of subrogation
endorsement CA0444 1013 to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such
status. Policy include a blanket 30 day notice of cancellation endorsement SICA1028 1115 to the certificate holder only when there is a written contract between
the named insured and the certificate holder that requires such status.The Umbrella Liability Policy provides follow form excess limits over General Liability
(including Products and Completed Operations),Auto Liability and Employers Liability Insurance(with respect to Professional Employer Organization(PEO)
SOI/Heath Consultants INC client#7913 only).The policy includes Additional Insured status and waiver of subrogation regarding form number XS100 1008,to
the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status.