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CERTIFICATE OF LIABILITY INSURANCE (543) '`` CERTIFICATE OF LIABILITY INSURANCE D12/20/2019 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 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: Cathy Shadwick State Farm Agency 'MOAI,Ext):727-822-1333 ;�c "°: E- IL 3499 4th St. N ADDRESS: St. Petersburg, FL 33704 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: State Farm Mutual Automobile Insurance CO. 25178 INSURED Reuben Clarson Consulting INSURER B: 780 94th Avenue N Ste 102 INSURER C: St. Petersburg, FL 33702 INSURER D: 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 ADDTYPE OF INSURANCE INSR WVDSUBR POLICY NUMBER POLICY EFF POLICY EXP LTR MM DD/YYYY D MM D/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ CLAIMS-MADE 1:1 OCCUR F MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC $ JECT COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY F 117-8847-F-13-59H 12/13/2019 Ea accident $ ANY AUTO BODILY INJURY(Per person) $1,000,000 ALL OWNED SCHEDULED BODILY INJURY(Per accident) $1,000,000 AUTOS AUTOS 06/13/2020 $1'000'000 NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR F F EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE 999 999 AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ OFFICE/MEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION E.L.DISEASE-POLICY LIMIT $ F F DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPTION DATE THEREOF, 100 S. Mytrle Avenue ACCORDANCE WITH THE POLICY PROVISIONS.E WILL BE DELIVERED IN Clearwater FL 33756 Attn: Carrie Czurly AUTHORIZED REPRESENTATIVE © 198W-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD