CERTIFICATE OF LIABILITY INSURANCE (2) Page I of 2
DATE(MWDD,.YYYY)
CERTIFICATE OF LIAB ILITY INSURANCE 12/28/2022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
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: it 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 CNA Ef WL-Il" T-Wwrw_Watson Certificate Center
-___M7 - - � 111-1---------��1--p. _____--_-_
Willis Towers Watson Northeast, rnc. PHONE xx
1-877-945-7378 WC IN 1 1-888-467-2370
c/o 26 Century Blvd E--.—
iC NO
P.0, Box 305191 cortificates@willis.Coro
Nashville, Ts; 372305191 USA INSURER( He! COVERAGE "'NAIL#
............
!NSUREBA: ACE American Insurance company 22667
INSURED INSURER . ACE Property & Casualty Insurance company 20699
Zeno Office Solutions
0701 Florida Mining Blvd #8709 INSUREA C: Ind—ity Tnourance Company of North hmsri! 43575
Tampa, rL 33623 INsuRERD: ACE Fire Underwriters Insurance company, 207(12
INSURER
INSURER F:
COVERAGES CERTIFICATE NUMBER.W27432335 REVISION NUMBER.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERM
INDICATED. NOTWITHSTANDNG ANY REQUIREMENT, TERM 08 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.
IALSRR, "' ,TYPE OF INSURANCE 'AINboDL'SWUYlDkPOUCY NUMBER 061 YYUYyPyROWn,
yoyI LIMIT'S
X COMMERCIAL GENERAL LIABILITY
EACHOCCURRENCE $ 2,000,000
'X, OCCUR 2,000,000
CLAIMSWADE
A MED EXP(Ariy Caere porton) 5
EDO 072955043 01/01/2023�02/01/20242,000,000
PERSONAL&ADV INJURY. $
_9ENl AGGREGATE LIMIT APPLIES PER GENERAL AGGFIEGATE 10,000,000
X POLICY PRO' LOC PRODUCTS-COMP,OP AGO !$ 2,000,000
JECT
OTHER:
?5LE LIMIT $ 5,000,000
AUTOMOBILE LIABILITY
I COMBINED SIN
I&a gpi,denh-_
ANY AUTO LSO DTLY INJUnY(Pe;persuri) $
A OWNED SCHEDULED ISA H25574631 01/01/2023;01/01/2024 00MLYINJURY Ter accidem)
AUTOS ONLY AUTOS i
HIRED NON-OWNED PROPERTY DMAAGE
AUTOS ONLY Auros owy tPer 4cp Rfii)
X UMBRELLA LIAR XOCCURi FACHOCCURRENCE $
EXCESS UAB
CLAWS-MADE XZU G2820176A 007 01/01/2023 01/01/2024 AGGREGATE 5,000,000
OLD ; 1 RETENTION$
WOnKERS COMPENSATION PER i
X�'STATUTE �
AND EMPLOYERS'LIABILITY
Y 1 N
fl c !ANYPRopRiFrORtPAFiTNER,EXECUTIVE E L.EACH ACCIDENT 1,000,000
1 1$
OFFIC PRIMEMBER EXCLUDED? tqo NIA WLR 068926737 01/01/2023101/01/2024'
(Maodiiory in MR) F.L.DISEASE EAEMPLOYE& $ 11000,000
----------
Me,aescrilm under 21000,000
0 SCRIPTION OF OPERATIONS bebw El.DISEASE�POLICY LIMIT 1$
A Workers Compensation and WLR C68926615 01/01/2023!01/01/2024Z,L. RACH ACCIOR01 �$1,000,060
Employers' Liability E.L. DISEASE -KA EW $1,000,000
Per Statute N.L. DISKASE -POLICY $1,000,000
DESCRIPTION OFOPERATIIONS LOCATIONSr VEHICLES(ACORD tOl,Additional Rwwrks Schedule,may be Whwhed fl!more space Is requked)
SEE ATTACHED
int
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED SIEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Clearwater - Public Library System AUTHORIZED REPRESENTATIVE
1DO N. Osceola Ave.
Clearwa or, FL 33755
0 1968-2016 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
Ot ID; 23508509 BATCH: 2786518
20f2 4243
AGENCY CUSTOMER ID.-
LOC C
AC"R 0 ADDITIONAL REMARKS SCHEDULE Page 2 Of 2
14..�
AGENCY NAMED WSURED
Willis Towers Watson Northeast, Inc, Zeno Off.ice Solutions
8701 Florida Mining Blvd 48709
POLICY NUMBER Tampa, FL 33623
see page 1
CARRIER NAIL CODE
See Page I See Page I EFFECTIVE DATE: See Page I
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: .......__25._-..._ FORM TITLE: Sertificate of Liability Insurance
........... ........... ........... ..............
INSURER AFFORDING COVERAGE: ACE Fire Undez-writers Insurance Company NAIC#: 20702
POLICY NUMBERSCF C6892774 EFF DATE: 01/01/2023 EXP DATE: 01/01/2024
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 applies to workers compensation WI
ACORD 101 (2008101) C 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
SR ID: 23508509 RATCH: 2786518 CERT: w27432335