CERTIFICATE OF LIABILITY INSURANCE (1014) DATE(MM/DD/YYYY)
A�"® CERTIFICATE OF LIABILITY INSURANCE
04/08/2020
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(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 CONTACT Heather Ashlin
NAME:
Brown&Brown of Florida,Inc. (APHExt): (727)461-6044 a/c,No): (727)442-4695
Pinellas Division E-MAIL hashlin@bbpinellas.com
ADDRESS:
83 Park Place Blvd,Suite 101 INSURER(S)AFFORDING COVERAGE NAIC#
Clearwater FL 33759 INSURERA: National Fire Insurance Company of Hartford 20478
INSURED INSURER B: Continental Casualty Company 20443
Thomas Sign&Awning Co.,Inc. INSURER C: Valley Forge Insurance Company 20508
4590 118th Avenue North INSURER D: Underwriters at Lloyd's, London 22616
INSURER E:
Clearwater FL 33762 INSURER F:
COVERAGES CERTIFICATE NUMBER: CL201754314 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 ADDLSUBR TYPE OF INSURANCE POLICY EFF POLICY EXP
LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000
DAMAGE TO CLAIMS-MADE ❑OCCUR _PREMISES
Ea oTED
N""ence $ 300,000
MED EXP(Any one person) $ 15,000
A 5088655636 12/31/2019 12/31/2020 PERSONAL&ADV INJURY $ 1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2'000'000
POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000
JECT
OTHER: Employee Benefits $ 1,000,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
Ea accident
ANYAUTO BODILY INJURY(Per person) $
A OWNED SCHEDULED 5088520172 12/31/2019 12/31/2020 BODI LY I NJ U RY(Pe r accide nt) $
AUTOS ONLY AUTOS
HIRED NON-OWNEDPROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
PIP 10,000 PIP-Broadened or named $
UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 10,000,000
B EXCESS LAB CLAIMS-MADE 5088655653 12/31/2019 12/31/2020 AGGREGATE $ 10'000'000
DED I X1 RETENTION $ 10,000 $
WORKERS COMPENSATION X1 PER OTH-
AND EMPLOYERS'LIABILITY v/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
C OFFICER/MEMBER EXCLUDED? N/A 5088647214 12/31/2019 12/31/2020
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
Professional Liability Aggregate Limit $1,000,000
D ANE1542923.20 05/13/2020 05/13/2021 Each Occurance $1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Additional insured includes City of Clearwater Parks Recreation Department.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
City of Clearwater Parks Recreation Department ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 4748
AUTHORIZED REPRESENTATIVE
Clearwater FL 33758-4748
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