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CERTIFICATE OF LIABILITY INSURANCE (523) 76/27/2019 E(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). CONT PRODUCER Liberty Mutual Insurance NAMEACT PO Box 188065 PHONE FAX Fairfield, OH 45018 A/C No Ext: 800-962-7132 A/C No: 800-845-3666 E-MAIL ADDRESS: BusinessService@LibertyMutual.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Ohio Casualty Insurance Company 24074 INSURED INSURER B: Ohio Security Insurance Company 24082 Reuben Clarson Consulting,lnc. 750 94th Ave N Ste 213 INSURERC: Saint Petersburg FL 33702 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 49605277 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 ✓ BKO58425458 3/31/2019 3/31/2020 EACH OCCURRENCE $1,000,000 DA CLAIMS-MADE 11/1 OCCUR PREM SES Ea occurrDence $200,000 MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 ✓ POLICY❑ PRO JECT ❑ LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION XWS58425458 6/18/2019 6/18/2020 �/ SPER TATUTE OERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVEF—] E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1.000.000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) RFQ#26-19 Certificate Holder is Additional Insured if required by written contract or written agreement subject to General Liability Blanket Additional Insured Provision. CERTIFICATE HOLDER CANCELLATION City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Jillian Pietro ACCORDANCE WITH THE POLICY PROVISIONS. 100 S. Myrtle Ave#220 Clearwater FL 33756 AUTHORIZED REPRESENTATIVE Lauren McCormick ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 49605277 1 58425458 1 19-20 Master Certificate Lauren McCormick 1 6/27/2019 6:12:55 AM (PDT) I Page 1 of 1 ® DATE(MMIDDIYYYY) ACC)REP CERTIFICATE OF LIABILITY INSURANCE hk. �- 0812312019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement($). PRODUCER CONTACT NAME: Stc7#eFarM Cathy Shadwick State Farm Agency PHMx 727-822.1333 FAX No 3499 4th.' Street N. E-MAIL ADDRESS: St.Petersburg,FL. 33704 INSURER(S).AFFORDING COVERAGE NAIL 4 INSURERA: State Farm Mutual Automobile Insurance Company 25178 INSURED INSURER B: Reuben Clarson Consulting INSURER C: 780 94th Ave N.,Suite 102 INSURER D: St Petersburg,FL. 33702 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 AODL SUER POLICY NUMBER MM DDYIYYYY MLICY EFF M1UpYfYYXYPY LIMITS LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 CLAIMS-MADE E OCCUR PREMISES Ea occurtence S MED EXP(Any one person) S PERSONAL&ADV INJURY 5 M'OTHER: L AGGREGATE LIMIT APPLIES PER; GENERAL AGGREGATE 5 POLICY PRO ❑ LOC PRODUCTS-COMPlOPAGG S JECT I 5 AUTOMOBILE LIABILITY 117-8847-F13-59H 08/13/2019 12/13/2019 COMBINED SINGLE LIMIT 5 Ea accident ANY AUTO E66-2353-1314-56 08/14/2019 02/14/2020 BODILY INJURY(Per person) 5 1,000,000 A OWNED F7 SCHEDULED BODILY INJURY(Per accident) s 1,000,000 AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE 5 1,000,000 AUTOS ONLY AUTOS ONLY Per accident 5 UMBRELLA LIAR OCCUR EACH OCCURRENCE 5 EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION 5 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY SEATUTE ER ANY PROPR4ETCRIPARTNERIEXECUTIVE Y❑ N 1 A E.L.EACH ACCIDENT s OFFICERIMEMB£R EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 5 If yes,describe under DESCRIPTION OF OPERATIONS below E,L.DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES(ACORD 101,Addltlonal Remarks Schedule,may be attached If more space is required) REFERENCE:IRFQ-#26-19;CITY OF CLEARWATER IS AN ADDITIONAL INSURED AS RESPECTS AUTO LIABILITY ONLY 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 POLIO PROVISIONS. 100 S.MYRTLE AVE.,#220 AURI 0 RE RESENTA CLEARWATER,FL. 33756 ATTN:JILLIAN PRIETO 988- 5 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered Marks of ACORD 1001486 132849.12 03-16-2016