CERTIFICATE OF LIABILITY INSURANCE (970)D: CR
—
ACCORD"
kr./CERTIFICATE OF LIABILITY INSURANCE
DATE (MIODDYYYY)
DATE
o7asr C
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 dons not Confer rights to the certificate holder in You of such endorsement(s).
PRODUCER 888-822-1173
Hawkins & Rawllnson, Inc.
P.O. BOX 3493
2515 East Glenn Ave, Ste 101
Ch36831-3493
Chuckuck Hawkins
kins
Near April Tillery
PHONE 888-822-1173 FAX 334-821-5801
Wc, No, Ext): I (NC, No):
mss: atilleryehrinsurance.com
INSURERS) AFFORDING COVERAGE
NAIC 0
INSURERA: BITCO General insurance Corp
20095
WRED 8eT$CoIncs, Inc.InC
rg-s Rd 190-171MarletPowder30064
INSURER B :
LC
AUGJ
OFFICIAL RECORDS
LEGISLATI\+E
INSURER C :
AND
DEPT.
INSURER D :
;
INSURER E :
$
xuruRCn r :
CLAIMS -MADE
•
•
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
LTR
TYPE OF INSURANCE
ADDLSUER
MSD
VAID
POLICY NUMBER�
,AERCIAL
POLICY EFF
POLICY EXP
yyYyl
LaIfTS
COMGENERAL LIABILITY
LC
AUGJ
OFFICIAL RECORDS
LEGISLATI\+E
12019
SRVCS
AND
DEPT.
EACH OCCURRENCE
;
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$
CLAIMS -MADE
OCCUR
MED EXP (My one person)
$
PERSONAL & ADV INJURY
$
UtNtRAL AOUNtliA It
$
LitNL Ati(71t(iA l t
HPOLICY [
OTHER:
UM I A-YLItb
2?--1-LOC
MK
PRODUCTS - COMP/OP AcG
$
s
AUTOMOBILE
_
LIABILITY
ANY AUTO
AUTO DONLY
AUTOS ONLY
__.
�AUUTNOOSDyU/LED�
ran*?
61 ED as ideMS NGLE LIMIT
(Ea
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
er eccRdent)AMAGE
$
$
_
UMBRELLA UAB
EXCESSLIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
../._____
$
AGGREGATE
$
UtU Ht I tN I ION Si
A1us
COMPENSATION
AND
ANYalt��� CUTIVE
Al
If yes, describe under
D SyyRIP11ON OF OPERATIONS below
YYN
N U A
WC 3683004
07/27/20 19
09/1112019
x1PATUTE 1 1am-
E.L. EACH ACCIDENT
$ 1,000'000
E.L. DISEA6E EA EMPLOYEE
$ 1.000,000
E.L. DISEASE - POLICY LIMIT
1,000,000
$
DESCRIPTION OF OPERATIONS 1 LOCATIONS t VEHICLES (ACORD 101, Add)ton° Remarks Wads* may be attested t mon specs Is ngiMed)
Grinding- Covered States: Alabama, Georgia, Kentucky, Florida, Maryland,
South Carolina, Texas. Grog Rogers is an excluded officer.
------- --- ----------
CITCL01
City of Clearwater
City Clerk
P 0 Box 4748
Clearwater, FL 33758./P"allial."1449
1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2010103)
O 1986-2015 ACORD CORPORATION. Ali rights reserved.
The ACORD name and logo are registered marks of ACORD