CERTIFICATE OF LIABILITY INSURANCE (847),acoRo° CERTIFICATE OF LIABILITY INSURANCE 7/30/2022
DATE(MM/DDIYYYY)
1 8/4/2021
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 rights to the certificate holder in lieu of such endorsement(s).
PRODUCER LOCKTON COMPANIES
CONTACT
NAME:
3657 BRIARPARK DRIVE, SUITE 700
HOUSTON TX 77042
866-260-3538
PHONE FAX
Ext): AIC No
E-MAIL
ADDRESS:
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE � OCCUR
y
Y
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A : ACE American Insurance CoWamny
22667
$ 2,000,000
INSURED HEATH CONSULTANTS INCORPORATED
1492477 9030 MONROE RD
INSURER B: ACE Property & Casualty Insurance Co
20699
INSURER C : Steadfast Insurance Comparly
26387
INSURER D: Tokio Marine Specialty Insurance Company
23850
HOUSTON TX 77061
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 17743125 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
LTR
TYPE OF INSURANCE
ADDL
SUBR
POLICY NUMBER
POLICY EFF
MM/DDIYYYY
POLICY EXP
MM/DDIYYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE � OCCUR
y
Y
XSL 672495834
7/30/2021
7/30/2022
EACH OCCURRENCE
$ 2,000,000
A AGE To
PREENTE
M SES Ea occu ence
$ 1000 000
MED EXP (Any one person)
$ 10,000
PERSONAL &ADV INJURY
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 4,000,000
X POLICY [] JE� [::] LOC
PRODUCTS - COMP/OP AGG
$ 4,000,000
$
OTHER:
A
C
AUTOMOBILE
X
LIABILITY
ANY AUTO
y
y
ISA H25557955
SXS 9582200-00
7/30/2021
7/30/2021
7/30/2022
7/30/2022
COMBINED SINGLE LIMIT
Ea accident
$ 5,000,000
BODILY INJURY (Per person)
$ XXXXXXX
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$ XXXXXXX
PROPERTY DAMAGE
Per accident
$ XXX�OXXX
X
HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
$ XXXXXXX
MCS -90
B
UMBRELLA LIAB
[EOL(
CUR
Y
Y
XOO G72535595 001
7/30/2021
7/30/2022
EACH OCCURRENCE
$ 10 000 000
AGGREGATE
$ 10,000,000
XEXCESS
LIAB
AIMS -MADE
DED RETENTION $
$ XXXXXXX
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
NOT APPLICABLE
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$ XXXXXXX
OFFICER/MEMBER EXCLUDED? ❑
(Mandatory in NH)
N / A
E.L. DISEASE - EA EMPLOYEE
$ XXXXXXX
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
1 $ XXXXXXX
D
Contractor's Pollution
Y
Y
PPK2307949
7/30/2021
7/30/2022
Gen. Agg/Ea. Claim
Professional Liability
$10,000,000/$10,000,000
Gen. Agg/Ea. Claim
$10,000,000110,000,00
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
All policies include a blanket notice of cancellation to certificate holders endorsement, providing for 30 days' advance notice if the policy is cancelled by the
company other than for nonpayment of premium, 10 days' notice if the policy is cancelled for nonpayment of premium. Notice is sent to certificate holders with
mailing addresses on file with the agent or the company. The endorsement does not provide for notice of cancellation if the named insured requests cancellation.
CERTIFICATE HOLDER CANCELLATION See Attachment
17743125
City of Clearwater
Attn: Purchasing Department ITB #06-19
PO Box 4748
Clearwater FL 33758
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
1011 W: &Zil67VA4•7:7.Z816101.7:7efr101k1IlellIRt'I�i-a
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
Attachment Code: D590843 Master ID: 1492477, Certificate ID: 17743125
All policies include a blanket automatic additional insured endorsement [provision] that
confers additional insured status to the certificate holder only if there is a written
contract between the named insured and the certificate holder that requires the named
insured to name the certificate holder as an additional insured. In the absence of such a
contractual obligation on the part of the named insured, the certificate holder is not an
additional insured under the policy.
All policies include a blanket automatic waiver of subrogation endorsement [provision]
that provides this feature only when there is a written contract between the named
insured and the certificate holder that requires it. In the absence of such a contractual
obligation on the part of the named insured, the waiver of subrogation feature does not
apply.
All policies contain a special endorsement with "primary and noncontributory" wording.