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CERTIFICATE OF LIABILITY INSURANCE (18)
A� 08/24/2020 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/2020 Y) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOTAFFIRMATIVELY 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 Jessica Komons NAME: Brown&Brown of Florida,Inc. a/cNNo Ext): (727)461-6044 FAX No ): (727)442-4695 Pinellas Division E-MAIL ) @p komons bb Inellas.com ADDRESS: 83 Park Place Blvd,Suite 101 INSURER(S)AFFORDING COVERAGE NAIC# Clearwater FL 33759 INSURERA: Southern-Owners Insurance Company 10190 INSURED INSURER B: FFVA Mutual Insurance Co. 10385 Clearwater Golf Associates,Inc. INSURER C: 1875 Airport Drive INSURER D: INSURER E: Clearwater FL 33765 INSURER F: COVERAGES CERTIFICATE NUMBER. CL2061827006 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 AUUL5UbK POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 CLAIMS-MADE FX OCCUR -PREMISES DAMAGOEa oNcurrreme $ 300,000 MED EXP(Any one person) $ 10,000 A Y 20115551 06/17/2020 06/17/2021 PERSONAL&ADV INJURY $ 1'000'000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2'000'000 X POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED 20115551 06/17/2020 06/17/2021 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED �/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY Per accident UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION X1 SPERTATUTE EORH AND EMPLOYERS'LIABILITY Y/N 1 00,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICER/MEMBER EXCLUDED? N/A WC84000161062020A 03/17/2020 03/17/2021 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1 00,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Liquor Liability Per Occurrence 1,000,000 20115551 06/17/2020 06/17/2021 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Excluded Officers:Jerry Huston,Julie Huston,John Huston,Suzanne Huston City of Clearwater is listed as Additional Insured with regard to General Liability if required by written contract. 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 ACCORDANCE WITH THE POLICY PROVISIONS. P.O.Box 4748 AUTHORIZED REPRESENTATIVE Clearwater FL 33758 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD