CERTIFICATE OF LIABILITY INSURANCE (998)A ^1 (J— ®
V� CERTIFICATE OF LIABILITY INSURANCE
4...--------
DATE (MMIDDIYYYY)
12/19/2019
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
BKS- Partners
4010 W Boy Scout Blvd. #200
Tampa FL 33607
CONTACT
NAME: Diane Cocking
PHONE FAX
No. Ext): 813-470-5038 (A/C. No): 813-221-1857
�A/c.
ADDRESS: diane.cocking@bks-partners.com
INSURER(S)AFFORDING COVERAGE
NAIC #
INSURER A : Westfield Insurance Company
24112
INSURED TBTRA-1
Tampa Bay Systems Sales, Inc.
dba Tampa Bay Trane
902 North Nimes Ave
Tampa FL 33609
INSURER B : Bridgefield Employers Ins Co.
10701
INSURER C: Indian Harbor
36940
INSURER D : Beazley Insurance Company, Inc
37540
INSURER E : Travelers Property Casualty Insurance Company
INSURER F :
PERSONAL a ADV INJURY
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.
ILTRR
TYPE OF INSURANCE
ANBD
BURR
POLICY NUMBER
CMM0154COVED
R
DEC26 2019
OFFICIAL RECORDS AND
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&A
IPOLICY
M DDIYYYY)
12/31/2019
(POLICY
M DD/ EXP
12/31/2020
LIMITS
OCCURRENCEEEAACHACTU
$1,000,000
A
X
COMMERCIAL GENERAL UABILI Y
RENTED
PREMISES (Ea occurrence)
$ 500,000
CLAIMS -MADE X OCCUR
MED EXP (My one person)
$1,000
PERSONAL a ADV INJURY
$1,000,000
GENERAL AGGREGATE
$ 2,000,000
GENT
AGGREGATE LIMIT APPLIES PER
POLICY I X I JCCOT Pr' LOC
OTHER:
PRODUCTS - COMP/OP AGG
$2,000,000
$
A
AUTOMOBILEua60
X
—
X
LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
X
_
X
SCHEDULED
AUTOS
NON -OWNED
AUTOS ONLY
PIP $10,000
T �r,7
CMND
1/2019
12/31/2020
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
E
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
ZUP15R6693818NF
12/31/2019
12/31/2020
EACH OCCURRENCE
$10,000,000
AGGREGATE
$10,000,000
Prod/CO Agg
$10,000,000 _T
DED
X
RETENT ON $1 n,0nn
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED?
(Mandatory In NH)
if m, describe under
DESCRIPTION OF OPERATIONS below
YIN
N
NIA
0830-52169
1/1/2020
1/1/2021
XOTH-
PER UTE ER
EL EACH ACCIDENT
$ 500,000
E.L DISEASE - EA EMPLOYEE
$ 500,000
EL DISEASE - POLICY LIMIT
$ 500,000
C
D
Profresslonel Liability
Cyber/Tech E&O
PEC004882903
W207CD180202
12/31/2019
12/31/2019
12/31/2020
12/31/2020
Each Loss
Each Loss
2,000,000
2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule. may be attached if more space is required)
CERTIFICATE HOLDER
CANCELLATION
City of Clearwater
112 S Osceola Ave
Clearwater FL 33756
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
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4
ACORD 25 (2016/03)
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