CERTIFICATE OF LIABILITY INSURANCE - RFQ 26-19 (19) MEAD&HU-01 MHORSFALL
ACORO°n CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
�••�-
11/9/2020
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 Melissa Horsfall
NAME:
Hausmann-Johnson Insurance,Inc. PHONE FAX
740 Regent Street 4th Floor (A/C,No,Ext):(608)252-9617 (A/C,No):
PO Box 259408 ADDRESS:melissa.horsfall@hausmann-johnson.com
Madison,WI 53725-9408
INSURERS AFFORDING COVERAGE NAIC#
INSURER A:The Travelers Indemnity Company of Connecticut 25682
INSURED INSURER B:Charter Oak Fire Insurance Co 25615
Mead&Hunt,Inc. INSURER C:Travelers Property Casualty Company of America 25674
2440 Deming Way INSURER D:
Middleton,WI 53562-1562
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER: 2019 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 NUMBER POLICY EFF POLICY EXP LIMITS
LTR INSD WVD MM DD YYYY MM DD YYYY
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE X OCCUR 6305C656013 12/1/2020 12/1/2021 DAMAGE TO RENTED 300,000
X PREMISES Ea occurrence $
MED EXP(Any oneperson) $ 10,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY LX PRO- � LOC PRODUCTS-COMP/OP AGO $ 2,000,000
OTHER: $
B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
Ea accident $
X ANY AUTO X 81011-275575 12/1/2020 12/1/2021 BODILY INJURY Perperson) $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY Per accident $
X HIREDX NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY Per accident)
ccident $
C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 9,000,000
EXCESS LIAB CLAIMS-MADE CUPOK301101 12/1/2020 12/1/2021 AGGREGATE $ 9,000,000
DED X RETENTION$ 0 $
A WORKERS COMPENSATION X PER OTH-
AND EMPLOYERS'LIABILITY STATUTE ER
Y/N UB8J2154321943E-OTH STAT 12/1/2020 12/1/2021 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE * N/A E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(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 $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if mores ace is re wired
RE:project RFQ#26-19.When required in written contract the certificate holder is listed as additionaPinsure�wit respect to commercial general liability
and commercial auto liability.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Cit of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Y ACCORDANCE WITH THE POLICY PROVISIONS.
1650 North Arcturas Building C
Clearwater,FL 33765
AUTHORIZED REPRESENTATIVE
ACORD 25(2016/03) U 1988-2015 ACORD CORPORATION, All rights reserved,
The ACORD name and logo are registered marks of ACORD