CERTIFICATE OF LIABILITY INSURANCE (1088)AC"R" CERTIFICATE OF LIP
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONL
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITL
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the
If SUBROGATION IS WAIVED, subject to the terms and conditions of t
this certificate does not confer rights to the certificate holder in lieu of s
PRODUCER
Willis Towers Watson Insurance services West, Inc.
c/o 26 Century Blvd
P.O. Bax 305191
Nashville, TN 372305291 USA
INSURED
WS -TBR, LLC
CIO itbert K. Currey S Associates, Ina.
One Beacon Streat, 22nd Floor
Boston, Ari► 02108
OVERAGES CERTIFICATE NUMBER. W22632063
Page I of l
BILIW INSURANCE D10/2 /2021Y'
Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
TE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
palicy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
to policy, certain policies may require an endorsement. A statement on
Lich endorsement(s).
CO ACT
NAME: Willis Towers Watson Certificate canter
P NE - 1-877-945-7378 WC No: 1-988-467-2378
mm: certificatssBxillia.com _
INSU RE R(S) AFFORDING COVERAGE NAIL It
INSURERA: Endurance Assurance Corporation 11551
INSURER B: SOmpo America Fire i Marina insurance Comp. 38997
INSURER C; Allied World National Assurance Company 10690
INSURER D :
INSURER E:
INSURERF: w -
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER
CERTIFICATE MAY BE ISSUED DR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM;
R TYPE OF INSURANCE ADDLSUBR - twPOLICYnrv�vvEFF j POLICY EXP
sn win POLICY 1711a1BER n�u,n,
A
X COMMERCIALGENERAL LIABILITY
CLAIMS -MADE X OCCUR
GEN'L AGO REGATE LIMIT APPLIES PER:
POLICYPRO• X LOC
- JECT
AND EMPLOYERS'LIABILITY
In
Y GGRIO011997503
YFN '
NIA
10127/2020104/01/202:
JCV51022HO 16/27/20201:04/01/2022
0309-2216 10/27/2020104/01/2022
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORO 101, Additional Remarks Schedule, may be attached it more space is requh
RIs: Starkey Ranch, 2500 heart Pine Ave., Odeaaa, FL
Certificate Holder is included as an Additional insured with regards to General Liat
REVISION NUMBER:
ED NAMED ABOVE FOR THE POLICY PERIOD
AUTOMOBILE LIABILITY
WHICH THIS
X ANY AUTO
9
OWNED �i SCHEDULED
AUTOS ONLY IAUTOS
1, 000, 000
HIRED I NON-OWNIED
500, 000
..... .. . .
AUTD9ONLY � AUTOS ONLY
C
X UMBRELLA LIAB X OCCUR
1,000,000
EXCESS LIAB CLAIMS -M
2.000,000
DED : X RFTENTIhNS 10, 000
AND EMPLOYERS'LIABILITY
In
Y GGRIO011997503
YFN '
NIA
10127/2020104/01/202:
JCV51022HO 16/27/20201:04/01/2022
0309-2216 10/27/2020104/01/2022
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORO 101, Additional Remarks Schedule, may be attached it more space is requh
RIs: Starkey Ranch, 2500 heart Pine Ave., Odeaaa, FL
Certificate Holder is included as an Additional insured with regards to General Liat
REVISION NUMBER:
ED NAMED ABOVE FOR THE POLICY PERIOD
DOCUMENT WITH RESPECT TO
WHICH THIS
a HEREIN IS SUBJECT TO ALL
THE TERMS.
LIMITS
EACH OCCURRENCE $
1, 000, 000
NTET-
PREMESES.IEa P[cu(renCe}_. $ ... _
500, 000
..... .. . .
MED EMP (Ally one peryonl, g
PERSONAL &ADV INJURY $
1,000,000
GENERAL AGGREGATE $
2.000,000
PRODUCTS -COMPICPAGG g
2,000,oao
Liquor Liability 'g
11000,000
COMBINED SINGLE LIMIT
a acadenl
BODILY INJURY (Per person) $
BODILY INJURY (Per w:ddent) $
PROPERTY UA -MAGES
JPer accident) ,
$
EACH OCCURRENCE $
51000,000
: AGGREGATE g
5,000,000
PER OTH,
_ $TArurE SER
E.L. EACH ACCIDENT $
_
E.L. DISEASE - fA EMPLOYEE: g
E.L. DISEASE • POLICY LIMIT S
:d}
ility coverage.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
!►U $ 2021
THE EXPIRATION HATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
Clearwater Gas System GAS ADMIN AUTHORIZED REPRESENTATIVE
North Myrtle Avenue
Clearwater,
Clear►ratar, FL 33755 �fiTJ r�_�IAY_
9)1986-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (201&03) The ACORD name and logo are registered marks of ACORD
ss Id: 21759600 BArck: 2287563
202 8673