CERTIFICATE OF LIABILITY INSURANCE (4) DATE(MI417DDIYYYY)
A`)EY CERTIFICATE OF LIABILITY INSURANCE 03/24/2020
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(5), 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 endorsed.
If SUBROGATION IS WAIVED,subject to the terms and 6onditlans of the policy,certain policies may require an endorsement. A staternent on
this certificate does not confer rights to the certificate holder In lieu of such endorsement(s).
PRODUCER LIC #Os29370 1-205=581-3330 CONTACT
NAME:. P3ex Russell
Edgewood.Partners. Insurance Center (EPIC) PHONE. 205-581=3331 No;205-250=1173
[Alabama: 'aranch - Branch ID 154913 E-MAIL
2901 .2nd .Avenue South, Suite 200 ADDRESS: Alex•Russell@epic}]rokers.com
_ !INSURER S AFFORDING COVERAGE MAIC#
Birmingham;. AL 35233 INSURERA:VALLEY FORGE INS CO' 20508
INSURED INSURERS: CONTINENTAL INS CO 35289
Magnolia River Services, Inc. CONTINENTAL CAS CO 20443
INSURER C:
408 Bank Street INSURERD:EVANSTON INS CO 3537$
INSURER E:
Decatur, AL 35601 INSURER F:
COVERAGES CERTIFICATE NUMBER:58827870 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 OONTRACT 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.
ENSRY
TYPE OFINSURANCE D'I POLICYNUMBER MMIDDIYYYY MMLDDrYYYY ! LIMITS
LTR
A ][ {COMMERCIAL GEN UAL LIABILITY X: X 5099259512 04/01/20 .04/01/21 I EACH OCCURRENCE S.1,000.,000
CLAIMS-MADET OCCUR 'PREMISES Ea occurrent® S 1:00.'000
I MED EXP[Any one person S 15,000
3 PERSONAL&ADVINJURY S 1,000,000
GEN'LAGGREGATE.LiMiTAPFLIESPER: I GENERALAGGREGATE S 2,000,000
POLICY�JEa LOC (PRODUCTS-COMNOPAGG1$ 2,000,000
OTHER: I.S
x x 6020542513 0.4/01/20 04/0.1/27. S COMBINED SINGLE LIMIT 5:.1,000,000
B I AUTOMOBILE LIABILITY Ea accident 1
X ANY AUTO € BODILY INJURYIPerpersnn) 5
OWNED I SCHEDULEDBODILY INJURY(Per accident).S
AUTOS ONLY AUTOS i
HIRED )..._.. NON-OWNED
x' {x ; Per accident $.
AUTOS.ONLY AUTOS ONLY ]I
I I 5
B x UMBRELLALTA9 7{ OCCUR 6020542527 04/01/20 04/01/21 EACH OCCURRENCE g:.10,000,000
EXCESS LIAB CLAWS-MADE }AGGREGATE 5 10.E000,000
CER I x RETENTIONS 101.000 .S -.
C WORKERSCOMPENSATION x 6057410648 04/01/20 04/01/21 i x .STATUTE ER"
ANO EMPLOYERS'LIA13IT-MYIN
ANYPROPRIETORIPARTNERIEXECUTIVE J NIA I E.L.EACRACCIDENT S 1,0000900OFFICERIMEMBEREXCLURED7
(MandatorylnNH) i E.L.OISEASE-EAEMPLOYE I.5'1,000,000
If yes,describe under 1.000;000.
0ESCRIPTIONOFOPERATIONS.below i E.L.DISEASE-POLICY LIMIT .$
D Pollution/Prof xi�abliit_y IWMV7PLO 004110 04/91%20 04/01/21 EachClaim/Agg 5,000,000
i
I
i
DESCRIPTION OF OPERAncNS 1.LOCATIONS!.VEHICLES(ACORD 101,Additional:Rarnainks ScFieduie,:may be attached If ri ore space Is.requlrnd)
*See attadhed addit:icnal..coverage 'wording*
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES:BE CANCELLED 8EFORE.
City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS:
P..O. Box 4748 AUTHORIZED REPRESENTATIVE
Clearwater, FL 33758, sy �r
I i75A
Q 18BB-2095 ACORD CORPORATION. All rights reserved.
ACORD 25.(2016103) The.ACORD.name and logo are registered marks.of ACO RD
ARussell
58827870
QATE
SUPPLEMENT TO CERTIFICATE OF INSURANCE 03/24/2o2o
NAME OF INSURED,Ragnolia River services, Inc..
Additional Descri0an of Oparat€ons/Remarks from Page_1;
Certificate holder is named as additional insured as respects to General and.Auto Liability .(orz a primary and
non-contributory basic) .as. required by written contract; Excess/Umbrella is follow form; General Liability
additional insured endorsement includes ongoing and completed operations;. Waiver ❑f subrogation is issued in fa ❑ .
of .certificate holder as respects to General Liability; Auto Liability and Workers Compensation as required by
written contract;: All:policies contain a 30 day notice of .cancellation (lo for non-Pay) subject t❑. policy terms
and conditions;
Ad d if ion al Information:
SLIAP(05104)