CERTIFICATE OF LIABILITY INSURANCE - RFQ 11-14 (2) AC"RaDATE tMMMo0yyYYI`
CERTIFICATE OF LIABILITY INSURANCE I
112512020
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER$ 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(les) must have ADDITIONAL INSURED Provisions or be ondotrso&
If SUBROGATION IS WAIVED, star to the terms and conditions of the policy, cortain policies may require an endorsement. A statement on
this certificate does not confer qhts to the Certificate holder in Neu of such ondorsomenti!).
CONTACT Parlyn KowalSki
PROCUCER NAMZ�
StateFarm Katherim jones Insurance Agency P"Ofte 727-44,7-8989 1 FAX 727-240-1448
575S.Hemles Ave-Suite M4 LAWL
paitynQkjonesagency,corn
Clearwater,FL 33764 INSOREN _FOMNG COVERAGE NMCO
INURER A State Farm Mutual Automobile lin3urance CoriVany i 25179
INSURED INSWER B
FovAw Aa; rates Archrtects,Inc,
Instumft C-
1421 Court St.Suite D
Clearwater,FL 33756 IKIRMER E
..............................
INSMIM F'
COVERAGES CERTIFICATE NUMBER- REVISION NUMBER.,
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ARCIVE FOR THE POLICY PERIOD
INDICATED, NOTAITHSTANDING ANY REQUIREMENT, TERM OR CONDMON OF ANY CONTRACT OR OTHER DOCLUENT%1TH RESPECT TO VWICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE, TERMS,
EXGLUSIONS AND CONDITION$OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
aPr AnoLSODR' POLICY ev ..............
LIS TYPE OF INSURANCE Map wvni POLICY NUIUSER,_- aft2n�"_Vvyl tMrAtblyYYY�
F'GLICY M LMTS
COSWIERCAAL GENERAL LIAINLITY EACH 0C QUVRCNCt
CLAIMS-4AADE OCCUR
MCD C',XPIAn Wl"_pbf%�
F't R-59!4AL&ADIV INJUIN V S ....................
GEN't,AGCAE,,0A1 1,041 IT AWL IF$K,W, O�IVEKAL AGGRE-r�ATE S
Policy Lj Jccr LA I-0c
AUTOMOBILE LIAINLITY Y 963 1626-01-690 13 011X2 O =20 OWT_& ,,
ANY AA T 0 S 1,000_000
B0U1LYLNJURYfPeraGWMt) S 1,SCC,000
AUTOS ONLY AUTI),l
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AA TOS ONLY AIJT09 OuLY fpa'ac-'aw'u,
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DED RUEI,4710ft S
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EMPLOYERS'LMMUTY YAN
ANY r-,-V-1 r L FACII&C0If)fN r 100,000
`xNe PINIEMAPA LXCLL1bf-b7 NiAl 9&CA-0596-6 03�25r201 9 03r25f2020 ...........
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(Mand ftry In NHI, F,L,oisr ksr-FA F MPL OYEE]S
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0F,1,;CR1PrI0�N QF I)PIFRATUI)NS Wow r L.045rA-451'-POLICY LWIT S 500000
DESCRPTM OF OPERATIONS I LOCATIONS r VEHICLES JACORD 101 AdaWwol ROM"&Stheds&,may III*imuawd 11 M*""Mco to rave d)
RFC#91.14
Addilmnall Insured and Lo,%S Payee-City of Clearwaler,
CERTIFICATE HOLDER CANCEL
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED REFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS.
100 S Mtte Ave#220 – -- 7
Clearwater,FL 33756 4TH6 A�zp"MLSTA7
0 1 d 5 AC12CORPORATION. All rights reserved.
ACORD 26(2016,103) The ACORD name and logo are 4tered marks of ACORD
IW14W 1321449.Q 03,16.V, 18