CLEARWATER GAS SYSTEM FACILITY REDEVELOPMENT - 15-0043-GA - CERTIFICATE OF LIABILITY INSURANCE (3) ACDATE(MM/DD/YYYY)
ORU®
CERTIFICATE LIABILITY I I I/l/2022 1 12/22/2020
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 Lockton Companies NAMEACT
444 W.47th Street,Suite 900 PHONE FAX
CAC.Kansas City MO 64112-1906E-MAIL Ext: A/c No
E
(816)960-9000 ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:Travelers Property Casualty Co of America 25674
INSURED WALBRII)GE ALI)INGER LLC INSURER B:The Travelers Indemnity Compariy 25658
1347929 777 WOODWARI)AVE.,SUITE 300 INSURER C:The Travelers Indemnity Company of Connecticut 25682
I)ETROIT MI 48226 INSURER D:Westchester Fire Insurance Company 10030
INSURER E:
INSURER F:
COVERAGES * CERTIFICATE NUMBER: 16930115 REVISION NUMBER: XXXXXXX
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
A X COMMERCIAL GENERAL LIABILITY y Y VTC27-CO8A097077-TIL-21 1/1/2021 1/1/2022 EACH OCCURRENCE $ 2,000,000
DAMAGE T
CLAIMS-MADE � OCCUR PREM SESOEa oecur ante $ 300,000
X CONTRACTUAL LIAB. MED EXP(Any one person) $ 10,000
PERSONAL&ADV INJURY $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY n PRO LOC PRODUCTS-COMP/OP AGG $ 2,000,000
JECT
OTHER: $
B AUTOMOBILE LIABILITY y y VTC2K-CAP-8A097053-IND-21 1/1/2021 1/1/2022 COMBINED SINGLE LIMIT $
Ea accident 2,000,000
X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS XXXXXXX
X HIREDX NON-OWNED PROPERTY DAMAGE $ XXXXXXX
AUTOS ONLY AUTOS ONLY Per accident
$ XXXXXXX
A X UMBRELLA LIAB X OCCUR N Y CUP-8A097089-21-25 1/1/2021 1/1/2022 EACH OCCURRENCE $ 35,000,000
D EXCESS LIAB CLAIMS-MADE 624245846010 1/1/2021 1/1/2022 AGGREGATE $ 35,000,000
DED RETENTION$ Prod-Comp Op Ag $ 35,000,000
WORKERS COMPENSATION PER OTH-
C AND EMPLOYERS'LIABILITY Y/N Y UBIL3401932125K 1/1/2021 1/1/2022 X STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ 1 000,000
OFFICER/MEMBER EXCLUDED? N 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
A CONTRACTORS N N QT-630-8A097575-TIL-21 1/1/2021 1/1/2022 $1,000,000 LEASED/RENTED
EQUIPMENT-ALL RISK
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
RE.CLEARWATER GAS COMPLEX REDEVELOPMENT-1-1370. CITY OF CLEARWATER IS AN ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY AND
AUTO LIABILITY COVERAGE ON A PRIMARY AND NON-CONTRIBUTORY BASIS AS REQUIRED BY WRITTEN CONTRACT,WAIVER OF SUBRGATION APPLIES IN
FAVOR OF THE ADDITIONAL INSUREDS AS RESPECTS GENERAL LIABILITY,AUTO LIABILITY,AND WORKERS COMPENSATION COVERAGE AS REQUIRED BY
WRITTEN CONTRACT AND WHERE ALLOWED BYLAW FOR CANCELLATION FOR ANY REASON OTHER THAN NONPAYMENT OF PREMIUM,THE INSURER(S)WILL
SEND 30 DAYS NOTICE OF CANCELLATION TO THE CERTIFICATE HOLDER.
CERTIFICATE HOLDER CANCELLATION
16930115
CITY OF CLEARWATER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
100 S. MYRTLE AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CLEARWATER FL 33756 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIV
O
1988L2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD