CERTIFICATE OF LIABILITY INSURANCE (1005) T2-RV18
- DATE(MMIDDIYYYY)
CERTIFICATELIABILITY I 2/1212020
THIS CERTIFICATE lS 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 HOLIER.
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 sloes not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CO TACT. .
NAME,
Commercial Lines PHONE888-572:2412' FAX
I. NGEXII;USI Insurance Services LLC E-YAIL carts trinet.com
2601 South Sayshore Drive,Suite 1600 INSURER S AFFORDING COVERAGE AIE #4
Coconut GTOVe,FL 33133 INSURER A; Indemnity Insurance Company of North America 48575
INSURED INSURER 8:
TdNet HR Xl,Inc. INSURER
RE.,Meath Consultants Incorporated� INSURER D: ...,_ _.....s ,:..
9GOO Town Center Parkway INSURER L '
Bradenton,FL 34202 INSURER F:
COVERAGES CERTIFICATE NUMBER. 14822488 REVISION" BEFt: See below
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED kgdA POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR.CONDITION OF ANY CONTRACT OR O`HER DOCUMENT WITH RES O 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,
INsti1 -TYPE
�_._., _ Y..
RDDL SsI�R POLICY EBF POLICY EXP
LTR{ TYr'E CF INuIJRANCE I I O P[,1LICY NUhRIiER 'NIDI5IYYYY I17dDO1YYYY LIIlNI'r5
COMMERCIAL GENERAL.LIABILITY EAC14 OCCURRENCE $
A �NaED
CLAM ISaR1Al E OCCUR PREMISES R'Ea oucurre ce) $
MED EXP[Arty one
P..ERSONAL&ADV INJURY 5
G,EN"LAGGREGATE..LIMIT APPLIES:PER: GENERAL AGGREGATE__is
EE POLICY JECT
POLICY �LOC PRODUCTS=COMPJOP AGG {S �.w.®._.
OTHER'_ i
COMEINED SINGLE LIM T I S
AUTOIr1t"BILE LIABILITY Ea
ANY AUTO BODILY INJURY(Per pessesnj S
_.
OWNED SCHEDULED BODILY INJURY(Per awident) S
AUTOS ONLY AUTOS
HIRED NON-OVifNEDI,....- -.nTY DAM..-. _.. ,....,,..m.,...PROPu=RTY AIvkP,C"F Y S
AUTOS ONLY _ AUTOS ONLY iFarauadectl 9
UMBRELLA UAP... �OCCUREACH OCCURREh9CE. 15
_..
EXCESS LKS CLAIMSYADE AGGREGATE is
OEO RETENTIONS is -
WORKERS COMPENSATION - -_ D31[71d2f32tt Q fU112.g21 � s71Y[1Tt'r [07H --
A IAND EMPLOY IPW LIABILITY YIN WLR 6x7467292 ,.w.. ....e -
ANYP€OPRIETORfPARTNER�EXECUTnlrz � E.1- EACH jcc DENT J s 2,[3IDIS.1 0
OFFICERMEMBEREXCLUDED? I- NIA -
(Mandatory in NH) E'.L I?ISE.ASE EA E@,tiPL£3YEEl s2,000,0QD
If es,describe under -. -- 2,000,000 ._
D SCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S
I
DESCRIPTION OF OPERATIONS;LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if mom space Is requiredl
Workers'Compensation is limited to worksite employees of Heath Consultants Incorporated through a co-employment contract with TdNet HR XI,Inc.
CERTIFICATE HOLDER CANCELLATION
City of Clearwater SHOULD ANY Or THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Clearwater Gas System ACCORDANCE WITH THE POLICY PROVISIONS..
PO Box 4748
Clearwater,FL.33758 AUTHORIZED REPRESENTATIVE
— The ACORD name and logo are registered marks of ACORD Q 19882015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016193) 111111111111111111111111111111111 IN 111111111111111111111111111111111111111111111111111 .r-YW2A122a ro.