CERTIFICATE OF LIABILITY INSURANCE (1070)KCITECH-01
A� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/Yl
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(sl.
PRODUCER
Lyons Insurance Agency, Inc.
501 Carr Road, Suite 301
Wilmington, DE 19809
INSURED
KCI Technologies, Inc.
10401 Highland Manor
Tampa, FL 33610
COVERAGES
Received
APR 0 6 2021
Of PLOMa
CERTIFICATE NLIMRER:
F:
472.2914
Union Fire
MI
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
ADOL
SUBR
POLICY NUMBER
POLICY EFF
POLICY EXP
DMS
A
X COMMERCUILGENERA UABILTTY
CLAIMS -MADE OCCUR
GL 522-24-13
411/2021
4/1/2022
EACH OCCURRENCE S
1,000,000
DAMAGETORENTEO s
500,000
MED EXP (Any one $
25,000
PERSONAL& ADV INJURY $
1,000,000
GEML AGGREGATE LIMIT APPLIES PER:
POLICY JELQT LOC
GENERAL AGGREGATE
2,000,000
PRODUCTS-COMP/OP AGG S
2,000,000
S
OTHER:
A
LUUiILRY
CEOMBINED SINGLE LIMIT
IS
'1,000 000
rMOSISLE
NYAUTOCA
WNEDSCHEDULED
UTEOOLYAUUTTOOSWNE
44&85.82
4/1/2021
4/1/2022
BODILYINJURv Per Bon S
BODILY INJURY Per accidentUTOS
ONLY AUTOS ONLOV
4/1/2021E411/2022
Perr e�alEaM AMAGE
EACH OCCURRENCE $
10,000,000
B
X
UMBRELLA UAB
EXCESS LIAR
X
OCCUR
CLAIMS -MADE
IT000202925-10
AGGREGATE $
10,000,000
DED X RETENTION$ 10,000
C
AND KERSEMPLGOERS' N LIABILITY
ANYPROPRIETOR/PARTNERIEXECUnVE YIN
))FflCER/MEMSER EXCLU FN
IWndatary in HI
R descnroe under
DESCRIPTION OF OPERATIONS belax
N / A
WC 012-01-61190
41112021
X PERTUTE OTH-
STA I
S
E1. EACHDISEASE
1,000,000
A EM
E.L DISEASE -EA EMPLOYEE $
1,000,000
E.L. DISEASE - POLICY LIMIT $
1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addelonal Remarks Schedule. may Ix attached N mom space is required)
Job Name: Allen's Creek Outfall
City of Clearwater are included as an Additional Insured under the General Liability
Policy if required by written contract. Coverage is primary and
non-contributory if required by written contract.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Clearwater
100 South Myrtle Ave. Suite 220
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Clearwater, FL 33756
AUTTHORIZIZED REPRESENTATIVE
ACORD 25 (2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and lean are registered marks of ACORn