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CERTIFICATE OF LIABILITY INSURANCE (1017)
^ Page 1 of 1 A`CO� CERTIFICATE OF LIABILITY INSURANCE DATE05/26//20202020 V. 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 1S 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!leu of such endorsement(s). PRODUCER CAMONTACTE: Willis Towers Watson Certificate Center Willis Towers Watson Midwest, Inc. fka Willis of Illinois, Inc_. PHONE 1-877-945-7378 FAX 1-888-467-2378 c/o 26 Century Blvd AfC No E-MAIL certificates@willis.com P.O. Sox 305191 ADDRESS: Nashville, TN 372305191 USA INSUR5R(SI AFFORDING COVERAGE NAIC# INSURERA: Crum & Forster Specialty Insurance Company 44520 INSURED INSURERB: selective Insurance Company of South Carol 19259 IBC Engineering-Environmental & Construction LLC NSW22295 Johnson Dr Ste 180 INSURERC• Selective Insurance Company of Southeast 39926 Waukesha, WI 531861853 _ INSURERD• INSUP.ER E INSURER F: COVERAGES CERTIFICATE NUMBER:W16516713 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPEOF INSURANCE POLICYNUMgER MMIDDNYYY) (MM1DD1YYYY1 LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAE TO CLAIMS-MADE �OCCUR PREMISES EaENTED occurrence $ $0,000 A MED EXP(Any ono person) 5 5,000 y EPA-130980 05/10/2020 05/10/2021 PERSONAL&ADV INJURY $ 11000,000 GEITLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY JET LOC PRODUCTS-COMPIOPAGG $ 3,000,000 OTHER: $ AUTOMOBILELUIBILMY COMBINED SINGLE LIMIT $ 2,000,000 Ea aeddeni ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED y s220395604 05/15/2020 05/15/2021 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED FNON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accide 1 $ UMBRELLRLIAB HOCCUR EACHOCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE; 1 $ DED I I RETENTION$ $ WORKERS COMPENSATION XPER AND E:MPLOYERS'LIABIUTY STATUTE ER C ANYPROPRIETOR/PARTNERIEXECUnVE YINEL EACH ACCIDENT $ 100,000 OFFICERIMEMBEREXCLUDED7 No NIA WC79363213 05/15/2020 05/15/2021 108,000 (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ if yes•describe under SOD,D00 DESCRIPTION OF OPERATIONS belay E.L.DISEASE-POLICY LIMIT $ A Professional Liability EPK-130980 05/10/2020 05/10/2021 Per Claim: $1,000,000 Aggregate: $3,000,000 DESCRIPTION OF OPERATIONS ILOCAMONS/VEHICLES(ACORD 101,Addltlonal Remarks Schedule,may be attached lrmore space Is required) City of Clearwater is included as an Additional Insured as respects to General Liability and Auto Liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Clearwater AUTHORIZED REPRESENTATME 100 South Myrtle Avenue Clearwater, FL 33756 Ctst� ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) . The ACORD name and logo are registered marks of ACORD sx xn: 19649826 shTca, 1689723