CERTIFICATE OF LIABILITY INSURANCE (1108) ACQRD0 DATE(M?41t) YYYY)
CERTIFICATE OF LIABILITY INSURANCE 1a11sizo2z
THIS CERTIFICATE 19 ISSUED AS A MATTER.OF INFORMATION ONLYAND CONFERS No RIGHTS UPON THE:CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOTAFFIRMATIVELY OR NEGATIVELYAMEND,EXTEND OR ALTER THECOVERAGE AFFORDED BY THE POLICIES
BELOW THIS.CERTIFICATE OF INSURANCE DOES.NOT CONSTITUT6A CONTRACT BETWEEN THE ISSUING INSURER(%AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT, tf the certificate holder is an ADDITIONAL INSURED,#he.policy(ies)must have ADDITIONAL INSURED provisions.or be endersed:
if SUBROGATION IS WAIVED,subject-to the.terms and conditions of the policy,certain pollcies.may require an endorsement. Astatement.an
this certificate[foes not confer rights to the certificate holder in lieuof such endorsementi(s).
PRODUCER . TOT Amanda:Yoder-Carr
CGB Insurance,LLC PHONVe. (813Y.749m7948 No: (913)200-2120
2531 Green Forest Lane est
ADDRESS- Amandagcg binsuranae.rrom
#10.1 INSURER(S)AFFORDING COVERAGE NAlC
Lutz FL 33558INsuR1 RA: Main StreetAmadca Protection Ins Co 13026.
INSURER INSURER R- Main Street Amedra Group(formerly Old Dominion) 13026
Florida Gas&Plumbing,Inc INSURERC: Old Dominion Ins Co 40231
5580 661h$t N INSURER D: Lloyds of.Lnndon
INSURER E'i
St Petersburg FL 33708 IMURER F:
COVERAGES. CERTIFICATE NUMBER: .2022-2023 Master REVISION NUMBER:
THIS IS TO CERTIFY THATTHE:POLICIES'OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THF INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATEp, NOTWITFiST,ANDINGANYREQUIREMENT,TERM OR CONDmoN.OFANY CONTRACT OR OTHER DacuMENT WITH RESPECTTO WHICH THIS
CERTIFICATE MAY BE ISSUED OR IMAY:PERTAIN,THE iNSURANCEAFFORDED BYTHE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE'TERMS,
E7(CUISIONS ANOCONDITIONS OF SUCH POLICIES.LIMITS;SHOWN MAY HAVE BEEWREDUCED BY PAIL]CLAIMS.
INSR POLICY EFF POLICY EXPLTR TYPEOFINSURAN£E (NSU WVD POLICYNISIAHER NIM0 MIDD L1MiT5
X COMMERMI-GENERALLUIS€LnY
EACH OCCURRENCE $DAMAGETO
1,00O,OOt}
CLAIMS-MADE OCCUR PREMISES occuireieco $ 500,000
MED EXP LAny ono person] S 10;000
A Y MPP3987X 09/08/2022 0910812023 PERSONAL&ADV INJURY g 1;000,004
GEVI-AGGREGATELIMATAPPLIES PER:. GENERALAGGREGATE 3 2,000,UOD
PRO- 2;OpO;ffOO
POLICY JECT LOC PRCDIXTS-COMPIOPAGG' S
OTHER: $
AUMM0131LELmBLrrY C6M.SIHED.SINGLE LtN3T 'g 1,000,000
Ea aced n
X ANYAUTO :.SOtlEY[I'I.}URY(Per pe*n) �
B OWNED SCHEDULED. B 1 P3887X 09/08/2022 0910812023: BOB ILY.iNJURY{Par noddont) S
AUTOS ONLY AUTOS
HIRED. NOH-OWNED PROPERTY DAMAGE
ALTOS ONLY AUTOS ONLY Peracsldenl
S
UMBRELLA UABOCCUR EACH OCCURRENCE .g 1.000.000
C. :�[ EXCESS LJAB CLAIM -KADE CUg3887)C 491U8f2022 09(0812023 .AGGREGATE $ 1.000;000
DFD I X1 RETENTION.$ 1.0,000 S
WORKERS COMPENSATION PER OTH-
AND EMPLOYER$'LUIBILnYYIN STATUTE ER
ANY OFFICE PRIMBERPARTNERIE7fECLI77VE NIA E.L EACHACCIDEHT S
OFFICERfN4EMSER EkCLUI.SED7 El
(Mandatory In NH) E.L.DISEASE-.EA EMPLOYEE S
1/9es,dine under
OFSCPJPTION Or OPERATIONS l ekw E.L.DISEASE-POLICY U-Mrr S
D Professional Lability SOP2.021ODBOOS 11125!2021 11P2512022 $1,cm.00O.
DESCRMPM.N OF oPERATioNsI LOCATIONS.!VEHICLES{ACORD 141,AcIftonatRanTaft Wadula,rnayLa attaichedlrmore spacals regvired}
City of Gearwater'are liatc d.as additionat imureds'for General Liability purposes only.
i
f
I
CERTIFICATE BOLDER CANCELLATION
I SHOULD ANY OF THE ABOVE.DESCRIBED POLICIES BE CANCELLED:BEFORE
THE EXPIRATION DATE THEREOF.NOTICE WILL BE DELIVERED IN
City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS.
100 S.Myrtle Ave
AurKOR[EED REPRESENTATNE
Clearwater FL 33755
[fir 198.34015 ACCORD CORPORATION. Al rig It ts.reserved.
AGORD 25(2016108) The ACORD name and.1ogo are registered marks of ACGRD