CERTIFICATE OF LIABILITY INSURANCE (973) DATE(MM/DDYYY)
A�" /YCERTIFICATE OF LIABILITY INSURANCE 4/28/2025
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: Greyling COI Specialist
Edgewood Partners Insurance Agency PHONE FAX
3780 Mansell Rd. Suite 370 A/C No Ext): 770.670.5324 A/C,Noy 770.670.5324
E-MAlpharetta GA 30022 ADDRESS: greylingcerts@greyling.com
INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA:The Continental Insurance Company 35289
INSURED HWLOCHNE INSURER B: National Fire Insurance Co of Hartford 20478
H.W. Lochner, Inc.
225 W. Washington Street, 12th Floor INsuRERc:American Casualty Co of Reading, PA 20427
Chicago, IL 60606 INSURER D: Lloyd's of London 85202
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:1295121165 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 POLICY NUMBER MM/DD MM/DD
B X COMMERCIAL GENERAL LIABILITY 7092014905 5/1/2025 5/1/2026 EACH OCCURRENCE $1,000,000
DAMAGE S( RENTED
CLAIMS-MADE OCCUR
PREMISES Ea occurrence)
ccurrence) $1,000,000
MED EXP(Any one person) $15,000
PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
POLICY❑ PRO
JECT LOC PRODUCTS-COMP/OP AGG $2,000,000
OTHER: $
B AUTOMOBILE LIABILITY 7091863062 5/1/2025 5/1/2026 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
A X UMBRELLA LAB X OCCUR 7092036547 5/1/2025 5/1/2026 EACH OCCURRENCE $15,000,000
EXCESS LAB CLAIMS-MADE AGGREGATE $15,000,000
DED X RETENTION$1 n nnn $
C WORKERS COMPENSATION 7092004665(AOS) 5/1/2025 5/1/2026 X PEROTH-
A AND EMPLOYERS'LIABILITY STATUTE ER
YIN 7092009168(CA) 5/1/2025 5/1/2026
ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $1,000,000
OFFICE R/M EMBER EXCLUDED? FN] N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
D Professional Liability incl. B0572MR25ACUZ 5/1/2025 5/1/2026 Per Claim $10,000,000
Pollution Liability Aggregate $10,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Re:Master 7830; City of Clearwater Engineer of Record RFQ 16-12
CERTIFICATE HOLDER CANCELLATION
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.
Attn: City Clerk
PO Box 4748 AUTHORIZED REPRESENTATIVE
Clearwater FL 33758-4748
.I
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