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CERTIFICATE OF LIABILITY INSURANCE
1 ® A� D CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 8/22/2022 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 Scott Insurance - Raleigh 2501 Blue Ridge Road Suite 250 Raleigh NC 27607 CONTACT Toni Dyer PHONE FAX (NC. No. Ext): 919.341.0746 (A/C, No): 434.455.1469 ADDRESS: tdyer@scottins.com INSURER(S)AFFORDINGCOVERAGE NAIC# INSURER A: Berkley Assurance Company (A+) 39462 INSURED MCKI&CR-01 McKim & Creed, Inc. 1730 Varsity Drive Venture IV Building, Suite 500 Raleigh NC 27606-2689 INSURER B : INSURER C : INSURERD: $ INSURER E : $ INSURER F : COVERAGES CERTIFICATE NUMBER: 1945452360 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 LTR OF INSURANCE ADDLTYPE INSR IVSD SUER WVD POLICY NUMBER EFF (MPM/DDY /YYYY) POLICY EXP (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE PREM SESO(Ea occu ence) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GE 'L AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY ' SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENT ON $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITYY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below / N N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A A Professional Liability Contractors Pollution Liab PCAB-5019049-0922 PCAB-5019049-0922 9/5/2022 9/5/2022 9/5/2023 9/5/2023 Each Claim/Aggregate Each Claim/Aggregate Self-In/ssdd Retention I /E M $5M / $10M $5M / $1OM ' $500K / $1M DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) , `ECE AUG 29 OFFICIAL RECORDS LEGISLATIVE W 2022 AND SRVCS DEPT, CERTIFICATE HOLDER CANCELLATION o O City of Clearwater Attn: City Clerk P.O. 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 /(� 2D 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SCOTT INSURANCE 1301 OLD GRAVES MILL RD LYNCHBURG VA 24502-4317 001476 1 6 6 ***************AUTO**MIXED AADC 956 CITY CLERK City of Clearwater PO Box 4748 Clearwater FL 33758-4748 II" IIIPII'IIIiliI,iIiiilil iliiiiIiiII'IIII'IIIIIiir i1111,11 Employee Owned SCO1 T Est. 1864 In our continuing effort to provide timely certificate delivery and based on trends from 2020 and 2021, Scott Insurance is transitioning to paperless delivery of Certificates of Insurance. To ensure electronic delivery for future renewals of this certificate, please provide your email address to be added to the certificate on file. Please either write your email address on the attached certificate of insurance and return, OR complete and return this document. INSURED: McKim & Creed, Inc. CERTIFICATE HOLDER: City of Clearwater PROJECT NAME/REFERENCE IF APPLICABLE: EMAIL ADDRESS FOR FUTURE DELIVERY: Please return this letter completed or a copy of your certificate of insurance with email address for future certificates via email to certs(c�scottins.com or fax to 434-455-7823. Please note that after June 30, 2023, printed certificates will no longer be available. If you no longer need this certificate, please return this page or a copy of page 1 of the attached certificate with a note that certificate is no longer required. Thank you for your cooperation and willingness in reducing our environmental footprint and providing timely certificate delivery. Sincerely, Scott Insurance 0 0