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CERTIFICATE OF LIABILITY INSURANCE (846) DATE(MM/DD/YYYY) A�"® CERTIFICATE OF LIABILITY INSURANCE 07/21/2020 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 Linda Fontenot NAME: Insgroup,Inc. PHONE (713)541-7272 FAX (713)772-5224 (AC, C No Ext): A/C,No 5151 San Felipe,24th Floor E-MAIL Ifontenot@insgroup.net ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Houston TX 77056 INSURERA: Starr Indemnity&Liability Company INSURED INSURER B: Indian Harbor Heath Consultants Inc. INSURER C: 9030 Monroe Road INSURER D: INSURER E: Houston TX 77061 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2072198060 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 $ 2,000,000 DAMAGE TO RETED CLAIMS-MADE ❑OCCUR _PREMISES Ea oN""ence $ 1,000,000 MED EXP(Any one person) $ 10,000 A 1000090437201 07/30/2020 07/30/2021 PERSONAL&ADV INJURY $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 4'000'000 JECT OTHER: Employee Benefits $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED 1000198851201 07/30/2020 07/30/2021 BODILY INJURY(Pe r accide nt) $ AUTOS ONLY AUTOS HIRED HNON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Mac UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 A 7X EXCESS LIAB CLAIMS-MADE 1000095274201 07/30/2020 07/30/2021 AGGREGATE $ 10,000,000 DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEF-1N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Pollution Liability Aggregate/Each Claim $10,000,000 B Professional Liability U500085663LI20A 07/30/2020 07/30/2021 Aggregate/Each Claim $10,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The General Liability policy includes a blanket additional insured endorsement OG 184 0412 and waiver of subrogation endorsement CG2404 0509 policy contains a special endorsement with the primary and non-contributory wording per endorsement CG2001 0413 to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status.Contractual Liability coverage provided by the policy is standard and may not cover all liabilities assumed by the named insured under the contract with the certificate holder endorsement CG0001 0413. Policy include a blanket 30 day notice of cancellation endorsement SII L 100 1014 to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status.The Auto Liability policy provide a blanket additional insured endorsement SICA1016 0414 waiver of subrogation endorsement CA0444 1013 to the certificate holder only when there is a written contract between the named insured and the certificate 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;Attn:Purchasing Department ITB ACCORDANCE WITH THE POLICY PROVISIONS. #06-19 AUTHORIZED REPRESENTATIVE P.O. Box 4748 Clearwater, FL 33758r @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 00071472 LOC#: ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Insgroup,Inc. POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance holder that requires such status. Policy include a blanket 30 day notice of cancellation endorsement SICA1028 1115 to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status.The Umbrella Liability Policy provides follow form excess limits over General Liability(including Products and Completed Operations),Auto Liability and Employers Liability Insurance(with respect to Professional Employer Organization(PEO)TRI NET HR XI/Heath Consultants INC client#T2-RV8 only).The policy includes Additional Insured status and waiver of subrogation regarding form number XS100 1008,to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD