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CERTIFICATE OF LIABILITY INSURANCE (562) DATE(MM/DD/YYYY) ACORN® CERTIFICATE OF LIABILITY INSURANCEF 9/24/2020 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 NAME: Certificates/Commercial Lines Wallace, Welch &Willingham PHONEFAX P.O. Box 33020 A/c No Ext): 727-522-7777 A/c,Noy 727-521-2902 St. Petersburg FL 33733 ADDRESS: certificates@w3ins.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Bridgefield Employers Ins.Co. 10701 INSURED CUM&F-1 INSURER B: Continental Insurance Company/CNA 35289 Cumbey&Fair Inc w 2463 Enterprise Rd suRERc:Argonaut Insurance Company 19801 Clearwater FL 33763 INSURER D: Transportation Ins.Co. 20494 INSURER E: Valley Forge Insurance Company/CNA 20508 INSURER F: COVERAGES CERTIFICATE NUMBER:1688027431 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 D X COMMERCIAL GENERAL LIABILITY 2086949437 3/16/2020 3/16/2021 EACH OCCURRENCE $1,000,000 CLAIMS-MADE ® OCCUR DAMAGETORENTED PREMISES Ea occurrence $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY ® PRO- ECT 1:1 LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ E AUTOMOBILE LIABILITY 2088208783 3/16/2020 3/16/2021 CO MBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIREDX NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ B X UMBRELLA LAB X OCCUR 2086949471 3/16/2020 3/16/2021 EACH OCCURRENCE $2,000,000 EXCESS LABCLAIMS-MADE AGGREGATE $2,000,000 DED X RETENTION$1 C non $ A WORKERS COMPENSATION 83054368 3/16/2020 3/16/2021 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/M EMBER EXCLUDED? FqN/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Professional/Pollution Liabilty 121AE000350501 3/16/2020 3/16/2021 Each claim $2,000,000 Claims made-retro date 2/19/16 Aggregate $2,000,000 Deductible $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Engineer of Record for RFQ#26-19 CF Project 19010 City of Clearwater is Additional Insured on a primary and non contributory basis with respect to General Liability if required by written contract subject to terms, conditions and exclusions of the policy form. City of Clearwater is additional insured on a primary basis with respect to Auto Liability if required by written contract subject to terms,conditions and exclusions of the policy form. See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Clearwater 100 S. Myrtle Avenue, #220 AUTHORIZED REPRESENTATIVE Clearwater FL 33756 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CUM&F-1 LOC#: AC40J?" ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Wallace,Welch&Willingham Cumbey& Fair Inc 2463 Enterprise Rd POLICY NUMBER Clearwater FL 33763 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 A Waiver of Subrogation in favor of City of Clearwater applies to General Liability,Auto Liability and Workers Compensation if required by written contract. ACORD 101 (2008/01) @ 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD