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CERTIFICATE OF LIABILITY INSURANCE (969) Client#: 1156666 79EQU IPCON DATE(MMIDDIYYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 7/26/2019 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT GA Certificate Team NAME: McGriff Insurance Services PHONE 770 471-7100 FAX, 877-657-1559 AIC,No,Ext): A/CNo 741 W. Lanier Ave.,Suite 100 E-MAIL ADDRESS: certificatesga@McGriffinsurance.com Fayetteville, GA 30214-GA INSURER(S)AFFORDING COVERAGE NAIC# 770 471-7100 INSURER A:West American Insurance Company 44393 INSURED INSURER B:Ohio Casualty Insurance Company 24074 Equipment Controls Company 24066 INSURER C:American Fire and Casualty Co PO Box 728 INSURER D: Norcross, GA 30091 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 CONTRACTOR 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 INSR WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY BKW2058718631 7/30/2019 07/30/2020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE FX]OCCUR PREMISESOEa occur°nce $1,000,000 MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY JECT � LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY BA02058718631 7/30/2019 07/3Ea accident0/2020 COMBINED SINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY FX AUTOS ONLY Per accident $ B X UMBRELLA LIAB X OCCUR US02058718631 7/30/2019 07/30/2020 EACH OCCURRENCE $4 000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE s4,000,000 DED I X RETENTION$10000 $ C WORKERS COMPENSATION XWA2058718631 7/30/2019 07/30/2020 X R OTH- PE AND EMPLOYERS'LIABILITY STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? � N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers Compensation Offices Excluded: James E Bell and James E Bell Jr. ""See Attached Forms" CG8810 0413 Commercial General Liability Extension Endorsement. CG8862 0413 Additional Insured-Blanket Vendors Endorsement. AC8501 0618 Business Auto Coverage Enhancement Endorsement (See Attached Descriptions) 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: Purchasing Department, ITB#53-15 ACCORDANCE WITH THE POLICY PROVISIONS. P O Box 4748 Clearwater, FL 33758-4748 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S24071008/M24050921 CALA