CERTIFICATE OF LIABILITY INSURANCE (1092) 712/17/2021
E(MM/DD/YYYY)
ACCORD® CERTIFICATE OF LIABILITY INSURANCE
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 CONTACT
NAME: Brlttanl Wiedemann
Heacock Insurance Group, LLC PHONE FAX
32313 Broadway St. A/C No Ext): 863-385-5171 A/c,No):863-385-4130
E-MSuite 101 ADDRESS: BWiedemann@heacock.com
Sebring FL 33870 INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA: Bridgefield Casualty Ins. 10335
INSURED DEVTSAL-01 INSURERB:Westfield Insurance 24112
Devtech Sales, Inc.
118 South Lake Avenue INSURERC:
Avon Park FL 33825 INSURERD:
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER:1622053489 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 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 INSD WVD POLICYNUMBER MM/DD MM/DD
B X COMMERCIAL GENERAL LIABILITY Y TRA7362681 1/1/2022 1/1/2023 EACH OCCURRENCE $1,000,000
CLAIMS-MADE OCCUR DAMAGE TO RENTED
PREMISES Ea occurrence $150,000
MED EXP(Any one person) $1,000
PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
X POLICY❑ PRO
JECT LOC PRODUCTS-COMP/OP AGG $2,000,000
OTHER: $
B AUTOMOBILE LIABILITY TRA7362681 1/1/2022 1/1/2023 COMBINED SINGLE LIMIT $1,000,000
Ea accident
X ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
X HIREDX NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
B X UMBRELLALIAB X OCCUR TRA7362681 1/1/2021 1/1/2022 EACH OCCURRENCE $5,000,000
EXCESS LAB CLAIMS-MADE AGGREGATE $5,000,000
DED X RETENTION$n $
A WORKERS COMPENSATION 19642434 1/1/2022 1/1/2023 X PERX OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? ❑ 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
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
Additional Insured in favor of the City of Clearwater applies to General Liability,when required by written contract or agreement. See attached endorsement.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Clearwater
P.O. Box 4748 AUTHORIZED REPRESENTATIVE
Clearwater FL 33756
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: TRA 7362681 COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
��^��������^���� �������NU ��� �����^�� ^��� ^������ �U� ��U^��
CONTRACTORS n�x���� / ��n�~» - SCHEDULED PERSON ��n� ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s) Location(s) Of Covered Operations
All persons or organizations when you have All Locations
agreed in writing in a contract or agreement
that such persons or organizations be added
as an additional insured.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section || Who Is An Insured is amended to 1. All vvork, including nna0eria|s. parts or
include asanadditional insured the person(s) equipment furnished in connection with
ororganizabon(s) shown inthe Schedule, but such work, on the project (other than
only with respect toliability for "bodily iryury''. service, maintenance or repairs) to be
11 property dannage" or "personal and adver' performed by or on behalf ofthe addi'
bsing iryury" caused, inwhole or in part, by: bona| insured(s) at the location of the
covered operations has been completed;
1. Your acts or omissions; or or
2. The acts or omissions of those acting on 2. That portion of ''your vvork" out of which
your behalf; the injury ordamage arises has been put
to its intended use bvany person oror-
in the performance of your ongoing oper' ganizabon other than another contractor
abons for the additional insured(s) at the or subcontractor engaged in performing
location(s) designated above. operations for a principal as a part of the
However: same project.
C. With respect 0o the insurance afforded 0o
1 The -''
� these additional insureds, the following is
insured only applies �o the extent per'
nnittedbvlaw; added to Section ||| Linnits0fInsurance:
- If coverage provided0othe ddib l insured
2. If coverage provided to the additional in' is required by a contract or agreement, the
sured is required by contract or agree' most we will pay on behalf of the additional
nnent, the insurance afforded to such insured is the amount ofinsurance:
additional insured will not be broader
than �ha� whichyou are required by the 1� Required by the contract or agreement;
or
contract or agreement to provide for
such additional insured. 2. Available under the applicable Limits of
�
B. With res Insurance shown in the Declarations;
� 0o the insurance afforded 0o
these additional insureds, the following addi' whichever isless.
bona| exclusions apply:
This endorsement shall not increase the ap'
This insurance does not apply to "bodily in' oUcabe Limits of Insurance shown in the
jury" or "property damage" occurring after: Declarations.
�Insurance Services Office,mo`oo10 C<32010 0413