CERTIFICATE OF LIABILITY INSURANCE (3)ACORD
CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
09/09/2020
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(les) 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
Marsh USA, Inc.
1301 5th Avenue, Suite 1900
Seattle, WA 98101
Attn: Seattle,CertRequest@marsh.com / FAX 212.948-4326
CN102835048-stn4-GAWUE-20-21
CONTACT
NAME:
NC. No, Exch A/C No):
E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC S
INSURER A: Travelers Property Casualty Company Of America
25674
INSUREDINSURER
Menito: Inc.
AIN:
AYvonne Tanak
2111 N. Molter Road
Liberty Lake, WA 99019.9469
B: The Travelers Indemnity Company
25658
INSURER C : XL Specialty Insurance Company
37885
INSURER D : NIA
NIA
INSURER E : National Union Fire Insurance Company of Pittsburgh,
$ 2.000,E
INSURER F : Allied World Specialty Insurance Company
16624
OVERAGES
CERTIFICATE NUMBER:
SEA -003585595.11
VISION NUMBER: 16
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.
INTSRR
TYPE OF INSURANCE
ADDL
5tJE
yV
3D
POLICY NUMBER
POLICY EFF
IMMIDDIYYYYI
POLICY EXP
IMMIDD/YYYI
LIMITSLIMITSNSD
A
_
X
COMMERCIAL GENERAL LIABILITY
HC2J-GLSA-9F337679-20
08/31/2020
08/31/2021
EACH OCCURRENCE
$ 2.000,E
CLAIMS -MADE X 1 OCCUR
TO RENTED
PREMISES (Ea Occurrence)
$DAMAGE
1,000,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
S 2,000,000
GENERAL AGGREGATE
$ 4,000,000
GENII_
X
AGGREGATEjLIMIT APPLIES`PER:
POLICY I 1 PRO- I I LOC
JECT
OTHER:
PRODUCTS AGO
$ 4,000,000
DEDUCTIBLE
$ 250,000
B
AUTOMOSLELIABILITY
X
X
ANY AUTO
OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
__
,-_
SCHEDULED
AUTOS
NON -OWNED
AUTOS ONLY
CAP -1J688782-20
08/31/2020
08/31/2021
COMBINEDBWGLELIMIT
(Ea acUdentl
9 2,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
S
PROPERTY DAMAGE
(Per accident)
$
Comp/Coll Deductible
$ 1,500
C
F
X
UMBRELLAIwB
EXCESS LIAR
X
_
OCCUR
CLAIMS -MADE
US00086273LI20A
03085725
08/31/2020
08/31/2020
08/31/2021
08/31/2021
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
DED I X I RETENT ONS 10,000
$
A
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNERIEXECUTIVE YIN
OFFICER/MEMBER EXCLUDED? U
(Mandatory In NH)
N yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
UB -8N023175 (AOS)
UB -8N033212 (WI, MA, NE)10/01/2020
70/01/2020
10/01/2021
10/01/2021
x I PEgruTE I I OTETH
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
S 1,000,000
E.L. DISEASE - POLICY LIMIT
1,000,000
S
E
Errors & Omissions
01-615.91.96
08/31/2020
08131/2021
Limit
SIR: $1,000,000
2,000,000
2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
Employee Dishonesty coverage is included in the Crime coverage. Errs s and Omissions coverage includes Cyber coverage.
City of Clearwater, Florida is included as additional insured where required by written contract with respect to General Liability and Auto Liability.
CERTIFICATE HOLDER
CANCELLATION
City of Clearwater, Florida
100 S Myrtle Avenue
Clearwater, FL 33756
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc
Peggy Boren 11PLEiSplL+�...-
ACORD 25 (2016/03)
®1988-2016 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD