CERTIFICATE OF LIABILITY INSURANCE (1054) DATE(MM/DD/YYYY)
ACORU®
12/14/2020
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: Sarah Liles
Heacock Insurance Group, LLC PHONEFAX
32313 Broadway St. A/c No Ext): 863-385-5171 A/c,Noy 863-385-4130
Suite 101
E-MAIL
sliles@heacock.com
Sebring FL 33870 INSURER(S)AFFORDING COVERAGE NAIC a
INSURERA: Bridgefield Casualty Ins. 10335
INSURED DEVTSAL-01 INSURER B:Westfield Insurance 24112
Devtech Sales, Inc.
118 South Lake Avenue
INsuRERc:
Avon Park FL 33825 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:701739081 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
B X COMMERCIAL GENERAL LIABILITY Y TRA7362681 1/1/2021 1/1/2022 EACH OCCURRENCE $1,000,000
CLAIMS-MADE OCCUR DAMAGE TO RENTED
PREMISES Ea occurrence $150,000
MED EXP(Any one person) $1,000
PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $2,000,000
JECT
OTHER: $
B AUTOMOBILE LIABILITY TRA7362681 1/1/2021 1/1/2022 COMBINED 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 TRA7362681 1/1/2021 1/1/2022 EACH OCCURRENCE $5,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
DED X RETENTION$() $
A WORKERS COMPENSATION 19642434 1/1/2021 1/1/2022X PER X OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? ❑ N/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
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
Additional Insured in favor of the City of Clearwater applies to General Liability,when required by written contract or agreement. See attached endorsement.
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
P.O. Box 4748 AUTHORIZED REPRESENTATIVE
Clearwater FL 33756
O 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: TRA 7362681 COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS/ LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s) Location(s) Of Covered Operations
All persons or organizations when you have All Locations
agreed in writing in a contract or agreement
that such persons or organizations be added
as an additional insured.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section || Who Is An Insured is amended to 1. All vvork, including maieria|s, parts or
include asanadditional insured the person(s) equipment furnished in connection with
ororganizaiionks> shown inthe Schedule, but such m/ork, on the project (other than
only with respect ioliability for "bodily injury^. service, maintenance or repairs) to be
^property damage" or "personal and adver' performed by or on behalf ofthe addi
iising injury" caused, in whole or in part, by: iiona| insured(s) at the location of the
covered operations has been completed;
1. Your acts oromissions; or or
2. The acts or omissions of those acting on 2. That portion of "your work" out of which
your behalf; the injury or damage arises has been put
to its intended use by any person oror-
in the performance of your ongoing opeF ganizaiionother than another contractor
aiions for the additional insured(s) at the orsubcontractor engaged in performing
location(s) designated above. operations for a principal as a pari of the
However: same project.
C. With respect to the insurance afforded to
1 The `'
� these additional insuneds, the following is
insured only applies to the extent per-
miKed by law; added ioSection ||| Limits OfInsurance:
- If coverage provided to the ddiii | insured
2. If coverage provided to the additional in' is required by a contract or agreement, the
suned is required bvacontract oragree- most we will pay on behalf of the additional
meni, the insurance afforded to such insured is the amount ofinsurance:
additional insured will not be broader
than ihaim/hichyou are required by the 1� Required by the contract or agreement;
or
contract or agreement to provide for
such additional insured. 2. Available under the applicable Limits of
�
B. With respect to the insurance afforded to in the Declarations;
orded io
these additional insureds, the following addi whichever isless.
iiona| exclusions apply: This endorsement shall not increase the ap'
This insurance does not apply to "bodily in' oUcabe Limits of Insurance shown in the
jury" or "property damage" occurring after: Declarations.
�Insurance Services Office,/o"..uu1u CG2O1O 0413