CERTIFICATE OF LIABILITY INSURANCE (535)Client#: 292011
35MCKIMCRE
page 2 of 3
ACORDr. CERTIFICATE OF LIABILITY INSURANCE
DATE
9/04/2019
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
McGriff Insurance Services
2108 W. Laburnum Ave Suite 300
PO Box 17370
Richmond, VA 23227
CONTACT
PHONE FAX
(A/C, No, Est)! 804 359-0044 (A/c, No):
8887513010
ADDRESS: certificatesvawv@mcgriffinsurance.com
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A : XL Specialty Insurance Company
37885
INSURED
McKim & Creed Inc.
1730 Varsity Drive #500
Raleigh, NC 27606
INSURER B :
_(MM/DD/YYYY)
INSURER C
I CLAIMS -MADE
INSURER D
OCCUR
INSURER E :
$
INSURER F :
COVERAGES
CERTIFICATE 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
LTR
TYPE OF INSURANCE
ADDLSUBR
INSR
WVD
POLICY NUMBER
POLICY EFF
POLICY EXP
(MM/DD/YYYY)
LIMITS
EACH OCCURRENCE
$
`_
COMMERCIAL GENERAL LIABILITY
_(MM/DD/YYYY)
I CLAIMS -MADE
OCCUR
DAMAGETO RENTED
PREMISES (Ea occurrence)
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GEN'L AGGREGATE LIMIT APPLIES
I PRO -
POLICY I JECT
OTHER:
PER:
LOC
GENERAL AGGREGATE
$
PRODUCTS - COMP/OP AGG
$
$
AUTOMOBILE
LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
■
SCHEDULED
AUTOS
NON -OWNED
AUTOS ONLY
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY (Per person)
_$
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA LIAB
EXCESS LIAB
■
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED
RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.
OFFICER/MEMBEREXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
Y / N
1
N/A
PER
STATUTE
OTH-
ER
EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
A
Professional
Liability
DPR9948365
09/05/2019
09/05/2020
$5,000,000 Per Claim
$7,000,000 Aggregate
$500K/$1 M Deductibles
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space Is required)
CERTIFICATE HOLDER
CANCELLATION
City of Clearwater
Attn: City Clerk
P.O. Box 4748
Clearwater, FL 33758-4748
ACORD 25 (2016/03) 1 of 1
1842 #S24267724/M24267205
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
®1988-2015 ACORD CORPORATION. All rights reserved.
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