CERTIFICATE OF LIABILITY INSURANCE (3) DATE(MM/DD/YYYY)
A�" CERTIFICATE OF LIABILITY INSURANCE 9i20i2022
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: Jennifer Roman
Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX
200 S. Orange Avenue A/C No Ext): 407-563-3553 .J C,No):
E-MSuite 1350 ADDRESS: Jennifer_Roman@ajg.com
Orlando FL 32801 INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA: United Educators Ins,a Reciprocal Risk Retention 10020
INSURED FLORCOL-01 INSURER B: Safety National Casualty Corporation 15105
St. Petersburg College
PO Box 13489 INsuRERc: Qualified Self Insurer
St. Petersburg, FL 33733-3489 INSURER D7
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:1880728363 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
A X COMMERCIAL GENERAL LIABILITY Y J0693Q 3/1/2022 3/1/2023 EACH OCCURRENCE $1,000,000
DAMAGE S( RENTED
CLAIMS-MADE OCCUR
PREMISES Ea occurrence)
ccurrence) $
MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,200,000
POLICY❑ PRO ❑
JECT LOC PRODUCTS-COMP/OP AGG $
X
OTHER: Retention(Ea Occ) $200,000
A AUTOMOBILE LIABILITY J0693Q 3/1/2022 3/1/2023 COMBINED SINGLE LIMIT $1,000,000
Ea accident
X ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
Retention(Ea Occ) $200,000
A UMBRELLA LAB X OCCUR J0693Q 3/1/2022 3/1/2023 EACH OCCURRENCE $4,000,000
X EXCESS LAB CLAIMS-MADE AGGREGATE $4,000,000
DED X RETENTION$1 nnn nnn $
B WORKERS COMPENSATION SP4066331 3/1/2022 3/1/2023 X PEROTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $2,000,000
OFFICER/MEMBER EXCLUDED? ❑ N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $2,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $2,000,000
C WORKERS COMPENSATION RM20220301 3/1/2022 3/1/2023 Self Insured $750,000
AND EMPLOYERS'LIABILITY Retention
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
Excess Aggregate applies to Products, Completed Operations, Employee Occupational Disease,Sexual Molestation and Athletic Traumatic Brain Injury.
License to use multiple sites for athletics.
Certificate Holder is shown as additional insured solely with respect to general liability coverage as evidenced herein as required by written contract to the
extent of such obligation and with respect to operations by or on behalf of the Named Insured or operations of facilities of the Named Insured or use of facilities
by the Named Insured(form BLX 06 2008).
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
PO Box 4748 AUTHORIZED REPRESENTATIVE
Clearwater FL 33758-4748
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD