CERTIFICATE OF LIABILITY INSURANCE (305) DATE(MM/DD/YYYY)
A�" CERTIFICATE OF LIABILITY INSURANCE 7/31/2019
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 rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME: Jason Travis
The Hilb Group of Florida, LLC-Tampa PHONE FAX
1345 S. Missouri Ave. A/C No Ext): 813-636-4000 A/c,No):813-281-1086
E-MClearwater FL 33756 ADDRESS: jtravis@hilbgroup.com
INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA: Phoenix Insurance Company(The) 25623
INSURED ADVASYS-01 INSURER B: Liberty Insurance Underwriters, Inc. 19917
Advanced Systems Engineering, Inc. INSURERC:Travelers Casualty and Surety Company 19038
13555 Automobile Blvd., #330
Clearwater FL 33762 INSURER D:Travelers Property Casualty Company of America 25674
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER:1177641226 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 POLICYNUMBER MM/DD MM/DD
A X COMMERCIAL GENERAL LIABILITY Y Y 660-1C914015 8/17/2019 8/17/2020 EACH OCCURRENCE $1,000,000
�
OCCUR DAMAGE TO
CLAIMS-MADE
PREMISES(E.
occurrence)
ccurrence) $1,000,000
MED EXP(Any one person) $5,000
PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
PRO-
POLICY� ECT 1:1 LOC PRODUCTS-COMP/OP AGG $2,000,000
OTHER: $
A AUTOMOBILE LIABILITY Y Y 660-1C914015 8/17/2019 8/17/2020 COMBINED SINGLE LIMIT $1,000,000
Ea accident
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
X HIREDX NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
D X UMBRELLA LAB X OCCUR Y Y CUP-11_307504 8/17/2019 8/17/2020 EACH OCCURRENCE $5,000,000
EXCESS LAB CLAIMS-MADE AGGREGATE $5,000,000
DED X RETENTION$1 n nnn $
C WORKERS COMPENSATION Y UB-8K553636 8/17/2019 8/17/2020 X PEROTH-
AND EMPLOYERS'LIABILITY Y/N STATUTEI ER
ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $500,000
OFFICER/MEMBER EXCLUDED? ❑ N/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
B Professional Liability AEE101878-0003 3/10/2019 3/10/2020 $2,000,000 Each Claim $2,000,000 Ann Agg
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Professional Liability coverage is written on a claims made and reported basis.Certificate holder is listed as an additional insured with respects to General
Liability,Auto Liability, Excess Liability policies on a primary and non-contributory basis.Waiver of Subrogation in favor of the additional insured applies to the
GL,Auto Liab,Excess Liability,&WC Policy
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.
City Clerk
PO Box 4748 AUTHORIZED REPRESENTATIVE
Clearwater FL 337584748
USA
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