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CERTIFICATE OF LIABILITY INSURANCE (551)Page 1 of 1 �Q® A� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIVYYY) 04/16/2020 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(les) 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 Willis Towers Watson Midwest, Inc. fka Willie of Illinois, Inc. c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA INSURED H.N. Lochner, Inc. 225 West Washington, Suits 1200 Chicago, IL 60606 CONTACT Willis Towers Watson Certificate Canter NAME: PHONE 1-877-945-7378 FAX 1-888-467-2378 IA/C, No. Ertl: (ANC. No): E-MAIL certificates@wiilie.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Beasley Insurance company Inc 37540 INSURER B : INSURER C: INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: W16210147 REVISION NUMBER: THIS INDICATED. CERTIFICATE EXCLUSIONS INSR LTR IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY .,....._.. - __-. . _... _...__-. ... _...rAML SIT: ff _.._._-__....-.._..__. . ,._'POLICY EFF TYPE OF INSURANCE SSD yYYO; POLICY NUMBER (MM/DD'YYYY) THE INSURED NAMED ABOVE FOR THE POLICY PERIOD OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, PAID CLAIMS POLfCY EXP ;__.- (MWDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY �///��►11�� RECEI ED L �/ APR 2 ,j tl1Lt I EACH OCCURRENCE $ CLAIMS -MADE i OCCUR DAMAGE TO RENTED f PR E�1l$�(a 4rre�L1 _ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY , : JECT ', I LOC GENERAL AGGREGATE $ PRODUCTS • COMP/OP AGG $ : OTHER: AUTOMOBILEUABIIJTY ANY AUTO SCHEDULED AUTOS NON -OWNED AUTOS ONLY OFFICIAL RECORDS AND LEGISLATIVE p SRVCS DEPT. 1 COMBINEDidem) SINGLE LIMIT $ Aga accident) BODILY INJURY (Per person) j $ OWNED t—' j AUTOS ONLY BODILY INJURY (Per accident) ! $ HIRED I AUTOS ONLY PROPERTY DAMAGE i $ (Per accd9nt)_ I$ 1 UMBRELLA LIAR � j OCCUR EACH OCCURRENCE : $ EXCESS UAB 1 CLAIMS -MADE I AGGREGATE $ I$ DED I I RETENTIONS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORJPARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory In NH) II y)s, describe under DESCRIPTION OF OPERATIONS Y / N N/A • ' t I STATUTE ERH E L. EACH ACCIDENT j $ E.L. DISEASE • EA EMPLOYEE $ below E.L. DISEASE • POLICY LIMIT :, $ A Professional Liability V2AEA4200101 05/01/2020 Retroactive Date 01/01/1944 05/01/2021"",Per Claim: i $1,000,000 ;Aggregate: 1$1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS i VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached N more space is required) Re: Master 7830; City of Clearwater Engineer of Record RIM 16-12 CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn: City Clerk PO Box 4748 Clearwater, FL 337584748 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 444, ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR SD: 19510574 BATCH: 1651302 2 of 2 1204 WILLIS TOWERS WATSON 26 CENTURY BLVD. 6TH FL NASHVILLE, TN 37214 1204 1 MB 0.436 11I1r11I IIluIlIlIllIIIIlllrlIIIIr1111"111111"IIIluInniuil CITY OF CLEARWATER PO BOX 4748 ATTN: CITY CLERK CLEARWATER, FL 33758-4748 1204 ****NOTICE**** In order to expedite distribution of certificates to Certificate Holders, we would like to begin using electronic distribution for future issuances. Also, we would like to remove any certificates that are no longer needed. If you would like to receive electronic copies in the future or no longer require a certificate for this Insured, please note as such below. Please complete this form and submit with a copy of your current certificate to the contact information below: Do you wish to receive renewal certificates: Yes [ ] No [ ] Require a hard copy be mailed: Yes [ ] No [ Email Address or Fax Number: SR ID: 19510574 If you require additional information or have further questions, please feel free to contact: Willis Towers Watson Global Certificate Center Email: EDPCERTS@willistowerswatson.com Fax: 888-467-2378 Phone: 877-945-7378 Please note that it is your responsibility to provide up-to-date contact information to assure correct distribution of any future renewal certificates. 1 of 2 1204