CERTIFICATE OF LIABILITY INSURANCE (1018) DATE(MM/DD/YYYY)
ACORN® CERTIFICATE OF LIABILITY INSURANCEF
06/09/2020
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 CONTANAME:CT Brett Briggs
Briggs Family Insurance Services, Inc. Aio,N Ext): (813)684-0400 A/c,No): (813)684-9230
611 E BLOOMINGDALE AVE STE A
E-MAIL brett@briggsfamilyinsurance.com
INSURER(S)AFFORDING COVERAGE NAIC#
BRANDON FL 33511-8127 INSURERA: GENESEE GENERAL
INSURED INSURER B: PROGRESSIVE AMERICAN INSURANCE CO
SOUTHERN AUTOMATION &CONTROLS, INC. INSURERC: BEAZLEY USA SERVICES, INC.
1042 VISTA CAY CT INSURER D:
INSURER E:
BRANDON FL 33511 INSURER F:
COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE OCCUR PREM SESOEa occur ence $ 100,000
MED EXP(Any one person) $ 5,000
A 1000302749 11/01/2019 11/01/2020 PERSONAL&ADV INJURY $ 1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000
JECT
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
Ea accident
ANY AUTO BODILY INJURY(Per person) $
B OWNED SCHEDULED 06651123-1 03/28/2020 03/28/2021 BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
$
UMBRELLA LAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION PER
TATUTE OTH-
AND EMPLOYERS'LIABILITY Y/N SER
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
C Professional Liability w/Cyber V1 B22D180301 04/01/2020 04/01/2021 $1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
CERTIFICATE HOLDER IS ADDITIONAL INSURED AS PERTAINS TO GENERAL LIABILITY AND COMMERCIAL AUTO LIABILITY COVERAGE.
CERTIFICATE HOLDER CANCELLATION
CITY OF CLEARWATER
ATTN: CLEARWATER GAS SCADA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
PO BOX 4748 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
CLEARWATER, FL 33758-4748
AUTHORIZED REPRESENTATIVE
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD