CERTIFICATE OF LIABILITY INSURANCE (1041) O-01 AFLEEGE
ACORO" DATE(MMIDDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE`—� 7/28/2020
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 License#OC36861 COONT CT Angela Fleege
Alliant Insurance Services,Inc. PHONE FAX
200 S Wacker Dr Ste 3030 (AIC,No,Ext): (312)930-1967 (AIC,No):
Chicago,IL 60606
E-MAIL
angelaf@proquestinsurance.com
INSURERS AFFORDING COVERAGE MAIC#
INSURERA:Nautilus Insurance Company 17370
INSURED Baker&Hostetler,LLP INSURER B:
Key Tower INSURER C:
127 Public Square INSURER D:
Suite 2000
Cleveland,OH 44114-1214 INSURER E:
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 NUMBER POLICY EFF POLICY EXP LIMITS
LTR INSD WVD MMIDDIYYYY MMIDDIYYYY
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS-MADE ❑ OCCUR DAMAGE TO RENTED
PREMISES Ea occurrence $
MED EXP(Any oneperson) $
PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY JjECT LOC PRODUCTS-COMP/OP AGG $
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident $
ANY AUTO BODILY INJURY Perperson) $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY Per accident $
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY Per accident $
El
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ g
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY YIN STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? NIA
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below _FE.L.DISEASE-POLICY LIMIT $
A Prof Liability PLP_1000023_P-13 10/31/2019 10/31/2020 See Description
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Insurer B:Swiss Re International SE,UK Branch AIIN#AA1370020
Insurer C:Underwriters at Lloyd's,London NAIC#15642
Insurer D:Scottsdale Surplus Lines Insurance Company NAIC#10672
Insurer E: National Fire and Marine Insurance Co:NAIC#20079
Limit of Liability in excess of$20,000,000 each Claim/$20,000,000 in the Aggregate
Claims-made coverage afforded on a subscription basis by Insurers A-E and various additional participating insurers
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Cit of Clearwater,FL THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Y ACCORDANCE WITH THE POLICY PROVISIONS.
Veronica Josef,Senior Staff Assistant
Engineering Department
PO Box 4748 AUTHORIZED REPRESENTATIVE
Clearwater,FL 33758-4748
f
ACORD 25(2016/03) 01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD