CERTIFICATE OF LIABILITY INSURANCE Page 1 of
4 DATE(EVI IDELYYYY
)
e TI LIABILITY INSURANCE 12/30/2021
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THIS
CERTIFICATE IS ISSUED AS A MATTER OF INF RMA71ON 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 policyfiesj 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 dues not confer rl hts to the certificate holder in lieu of such endorsement(s).
PRODUCER rClAEA Willis 'lowers 'Watson Certificate Center -
_.
Willis Towers
WatsonWataan. Northeast, Inc,a t. n .. PHONE ,.. .....
c/o 26 Century BlvdBlvdAt Ez 1-877-945-7378 AX N0: 1-888-467-23'78
._a_. va - ._._.._.. ..
E-MAIL
P.0. box 305191.. ADDA certiPicatsemillis dram
Nashville., rN 372305191 L.a.SA INSURBRd )AFFORDNGCOVERAGE MAIC9
— .— a- — - ---
...........
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INSURERA; ACS American insurance Company 22667
INSURED IN;URERB: ACE Property r Casualty Insurance Company 20699
Zeno Office Solutions, Inc,
1101 North Word Street INSURERC: Ind it11 y insurance 11 COmp ny of Nor11 th Ameri 43 11 5 11 75
Tampa, FL 33607-38241 INSURERO, ACC; Fire Underwriters Insurance coulpany 2070,2
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER.W23596268 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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 4bOCS{IBR P60610'
POLICY EXP
LTR TYPE OF INSURANCE POLICY NUMBER fuuMniv,YY ! Mh1 r56,'fV YY LIIATS
X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE 1 2,000,000
CLAIMS.°MADE X =UR 1}•RFINIS.,,►La n csttdrrjrn e} "i 2,000.000
A ICED EkP IA=ly c�rye per }ni C 5,000
O 672994325 01/01/2022 01/01/2023 ,..- �,= 2,040,000......
[ER�C3NAL kL AL Y INJURY 3
GE.I�#'f_.AGGREGATE LIMIT APPLsES PER.. ! �DENFRAL.AGGREGATE g, 10,000,000.
POLICY JECI LCC- PRODUCTS-COMPOP AGIS 5.... 2,000,000
.tcCT
AUTOMOBILE LIABILITY COMBINED`SINGLE LIMIT $ 5,000,000
X ANY At-TO BODILY INJURY!Per perscrn, $
A OWNED SCHECDuLE.D ISA H2555212A. 01/0112422 01/41....112023 BODILY INJURY(Porarcrdentd 1
.._.. , AUTOS ONLY _ AUTOS
MIRED NON-OWNED PRDPERTY DAMA,A 4
�._.AI.)rOS ONLY �y AUTOS€" JI (per mxderll) ..._ S_.
-----
UMBRELLA LIAR XOCC'LPR _ EACH OCCURRENCE S 5,000,000
B _ _ _
EXCESS IRAB CLAIRA S 1v4A(3E XXU G2020176A-006 01/01/2022 01,101/2023 TiGC3s3 t<4JATk
,aaa,aaa
DED RETENTIONS
WORKERS COMPENSATIONXPEROTP
AND EMPLGYER 'LIABILITY S ATWE ER
C *h YPROPPIE7OFrtfPARTNEREXE:CUI IVE. Y 7 N E.L EACH ACCIDENT r5_._ 1,000,000
'"OFFICE:Tt=MEMBER EXCLODE t3' No NIA WLR. C59.92227d 01/01/202.2 01/01/202.3
Bianditory In NH) E.L CDISEAgG EA EAAPIOYEE, $ 1,000,000
10 ye,.describe under � �. ._,. ,,.� _.n„ LL.�..�,.......LL-LL _._,._.....
DESCRIPTION OF OPERATIONS buow E.L DISEASE�POLICY LII'AIT ,6 1,000,000
-...A Workers Compensation and WLR 058...922239 01/01/2022 01/0112023 X.L. EACH ACCIDENT $1,000,000
Employers' Liability S.L. IDISGASS -SA EMP 511000,000
Per Statute .T.. DIS:: E -POLICY $1,000,000
DESCRIPTION OF OPERATIONS,,LOCATIONS,VEHICLES (ACOAD 101,ArkhO0nal Remarks Schedule,may be all had i!'more space is required)
SZE ATTACKED
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.
AUTHORIZED REPRESENTATIVE
Clearwater Public Library
100 N Osceola Ave
Clearwater, FL 33755
1988-2018 ACORD CORPORATION, All rights reserved,
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
ra `n' 22011/46 BATcr: 2355306
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AGENCY CUSTOMER ID:
LOC 4:
AC"R" ADDITIONAL REMARKS SCHEDULE Page 2 Of 2
AGENCY NAMED INSURED
Willis Towers Watson Northeast, Inc. Zeno office Solutions, Inc
1101 North Word Street
POLICY NUMBER Tm=Wa. rL 33607-3820
See page I
CARRIER NAIL CODE
See Page 1 See Page I EFFECTIVE DATE: See Page I
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS,FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER' FORM TITLE. Certificate of Liability Insurance
—'---'-'''---111111,111:1- —1-1 —.—' ............... ------ ---------------- .......
INSURER AFFORDING COVERAGE: ACE F ire Underwriters Insurance Company NAIC#'. 20702
POLICY NUMBER: SCF C68922318 EFF DATE: 01/01/2022 EXP DATE: 01/01/2023
TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:
Workers Compensation and E.L. EACH ACCIDENT $1,000,000
Employers' Liability E.L. DISEASE -EA EMP $1,000,000
Per Statute E.L. DISEASE -POLICY $1,000,000
ADDITIONAL REMARKS:
Policy mentioned above is -for Workers Compensation WI.
ACORD 101 (2008/01) C 2008 ACORD CORPORATION, All rights reserved.
The ACORD name and logo are registered marks of ACORD
SR ID: 22011506 BATCH: 2355306 CERT: W23596268