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CERTIFICATE OF LIABILITY INSURANCE (7)Client#: 93777 GOVEBRAN ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1 6/17/2021 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER Edgewood Partners Ins. Center CONTACT NAME: Patricia O'Neil PHONE 678-475-5738 FAX 770-232-9202 A/C, No, Ext : A/C, No 2405 Satellite Blvd., Ste. 200 Duluth, GA 30096 770 232-0202 E-MAIL atricia.oneil a Icbrokers.com ADDRESS: p p INSURER(S) AFFORDING COVERAGE NAIC# Hartford Fire Insurance Company 19682 INSURER A : P Y INSURED INSURER B: Hartford Casualty Ins. Co. 29424 Bi112Pay, LLC INSURER C: Indian Harbor Insurance Co 36940 9428 Baymeadows Rd. Ste 500 Jacksonville, FL 32256 INSURER D 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 CONTRACTOR 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP LIMITS MM/DD A X COMMERCIAL GENERAL LIABILITY X X 2000NEF2748 06/20/2021 06/20/2022 EACH OCCURRENCE $1,000,000 [X PREMISES CLAIMS -MADE OCCUR EaoccurrDence $300,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY JECOT LOC PRODUCTS - COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY X X 2000NEF2748 6/20/2021 COMBINED 06/20/202 (Ea acciden SINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED X X PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident B X UMBRELLA LIAB X OCCUR X X 20XHUEF3101 6/20/2021 06/20/2022 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $5,000,000 DED I X I RETENTION $10,000 $ A WORKERS COMPENSATION X 20WEAH8FBG 01/01/2021 01/01/202 X PER STATUTE ER OTH- AND EMPLOYERS' LIABILITY Y / N 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 C Professional Liab X MTP903664303 6/20/2021 06/20/2022 $5,000,000 C Cyber Liability X MTP903664303 06/20/2021 06/20/2022 $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Clearwater I Attn: Customer Service 100 South Myrtle Ave Clearwater, FL 33756 ACORD 25 (2016/03) 1 of 1 #S2769476/M2769442 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ,JL -:P © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD VBIA1