CERTIFICATE OF LIABILITY INSURANCE - RFQ 11-14 (568) A�" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)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 BRENDA M CORDER
NAME:
Town&Country Insurance Agency A/CNN Ext: 386 767 0147 A/c No: 386 767 5075
1525 Herbert St. Ste 106 a DD MAIL
BRENDA@TOWNC01.COM
INSURER(S)AFFORDING COVERAGE NAIC#
Port Orange FL 32129 INSURERA: HARTFORD INSURANCE COMPANY 29459
INSURED Williamson Dacar Associates Inc a/k/a Williamson INSURER B: HARTFORD INSURANCE COMPANY 00914
Dacar Donaudy INSURERC: CONTINENTAL CASUALTY COMPANY 20443
15500 Lightwave Dr., Suite 106 INSURER D:
Clearwater FL 33760 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 EFF POLICY EXP LIMITS
LTR INSD WVD POLICY NUMBER MWDD/YYY MWDD/YYY
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
DA E TORNTE
CLAIMS-MADE ® OCCUR PREM SES EMAGa occur ence $ 1,000,000
MED EXP(Any one person) $ 10,000
A X 21SBTY4564 09/24/2020 09/24/2021 PERSONAL&ADV INJURY $ 2,000,000
GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 4,000,000
POLICY❑ PRO-
❑
JECT LOC PRODUCTS-COMP/OPAGG $ 4,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 000000
Ea accident
ANY AUTO BODILY INJURY(Per person) $
A OWNED SCHEDULED 21SBTY4564 09/24/2020 09/24/2021 BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
X HIRED ®/ NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY X AUTOS ONLY Per accident
UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000
A EXCESS LIAB CLAIMS-MADE 21SBTY4564 09/24/2020 09/24/2021 AGGREGATE $ 2,000,000
DED RETENTION$ $
WORKERS COMPENSATIONSTATUTE OERH
AND EMPLOYERS'LIABILITY
B OFFICER/MEMBER EXCLUDED?ECUTIVE Y❑ N/A 21WECAClLPE 01/01/2020 01/01/2021 E.LEACH ACCIDENT $ 1,000,000
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
C PROFESSIONAL LIABILITY AEH591942751 09/14/2020 09/14/20215 111111
000000
EACH CLAIM ;
AGGREGATE 5,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
INSURED'S LOCATIONS: 15500 Lightwave Dr.Suite 106, Clearwater,Fl 33760
851 Broken Sound Parkway,Suite 133 Boca Raton, FI 33487
CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED WITH A WAIVER OF SUBROGATION IN THE FAVOR OF CITY OF CLEARWATER WITH
RESPECTS TO PROFESSIONAL SERVICES CONTRACT FOR MISC. CITY FACILITIES IMPROVEMENT PROJECTS ARCHITECT OF RECORD
RFQ 11-14
30 DAYS NOTICE OF CANCELLATION 10 DAYS NOTICE FOR NON PAYMENT OF PREMUM
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.
C/O ENGINEERING DEPARTMENT
PO BOX 4748 AUTHORIZED REPRESENTATIVE
CLEARWATER,FL 33758-4748
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