CERTIFICATE OF LIABILITY INSURANCE (71)
Rl.,urr~M \.I1:.t<. II r-1l;A II:. Ur- LIAtsl LII T IN:>>UKANl;t: I 02/19/2008
PRODUCER FAX (908)654-0332 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Slapin-lieb & Co. ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
200 Sheffield Street AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 104
Mountainside, NJ 07092-2314 INSURERS AFFORDING COVERAGE NAIC #
INSURED Malcolm Pirnie, Inc. INSURER A~ Commerce & Industry Ins. Co. 19410
104 Corporate Park Drive INSURER B: American Intnll Specialty Lines 26883
P. O. Box 751 INSURER c:
White Plains, NY 10602-0751 INSURER D:
JNSURE R E:
COVERAGES
THE PQUCJES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERtOD INDICATED. NOTWITHSTANDING
ANY REQUrREMENT, 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLuSrQNS AND CONDITIONS OF SUCH
POUCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
tNSR ~~~6 TYPE OF INSURANC E POUCY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR ...
GEN ERAL LIABILITY 02/01/2008 02/01/2009 EACH OCCURRENCE $ 1,000,000
X COMME RCIAL GENERAL UABILlTY DAMAGE TO RENTED $ 1,000,000
I--- o CLA~MS MADE [K] OCCUR fr, nr.r.L Irp.nr.p.~
GL 1633241 SEE ATTACHED MED EXP (Anyone person) $ 25,000
~
A FOR COMMENTS PERSONAL & ADV fNJURY $ 1,000.000
f----
IF ANY GENERAL AGGREGATE $ 2.000.000
r------
GEN'L AGGREGATE UMIT APPlI ES PER: PRODUCTS. COMP/OP AGG $ 2,000,000
I m PRO- m LOC
POLICY JECT
AUTOMOBILE LlASI LIlY CA 1633242 (MA) 02/01/2008 02/01/2009 COMBtNED SINGLE lIM IT
$
X ANY AUTO CA 1633243 (AOS) 02/01/2008 02/01/2009 (Ea accident) 1,000,000
-
ALL OWNED AUTOS BODll Y INJU RY
- (Per person) $
SCHEDU LED AUlDS
A -
X HI RE 0 AUTOS SEE ATTACHED BODIL Y INJURY
- $
X NON-OWNED AUTOS FOR COMMENTS (Per accident)
~
IF ANY PROPERTY DAMAGE
- (Per accident) $
GARAGE UABI UTY AUTO QNL Y & EA ACCIDENT $
=1 ANY AUTO OTHER THAN EA ACe $
AUTO QNL Y: AGG $
EXC ESS/UM BRE LLA UABI L1TY 02/01/2008 02/01/2009 EACH OCCU RRENCE $ 20,000,000
~ OCCUR D CLAIMS MADE UMB 1633244 AGGREGA TE $ 20,000.000
B SEE ATTACHED $
1 DEDUCTIBLE FOR COMMENTS s
RETENTION S (l IF ANY s
WORKERS COMPENSA lION AN D I we STATU- I IOTH-
TORY Ll MIT~ FR
EMPLOYERS. UABIUTY
ANY PROPRI ETOR/PARTNE RJEXECUTIVE E. L. EACH Acel DENT S
OFFICERlMEM BER EXCLU OED? E. L. DISEASE ~ EA EMPLOYE E $
If yes. describe under $
SPECIAL PROVISIONS below E_ L DISEASE. POLICY UMIT
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PRQVFSIONS
~#RE: All Operation of the Named Insured
. . ~ . See attached for details.....
"Except 10 days premium non-payment.
CERTIFICATE HOLDER
City of Clearwater
City Clerk
P.O. Box 5748
Clearwater, FL 33758
CANCELLATION
SHOU LD ANY OF THE ABOVE DEseRI BED PO L1CIES BE CANCE LLED BE FORE THE
EXPIRA TIO N DATE TH E REO F l THE I SSUJNG I NSU RER WI LL E NDEA VOR TO MAl L
30 of: DAYS WRITTE N NOTICE TO THE CERTI FICA TE HQ LDER NAMED TO TH E LEFT.
BUT F AI LURE TO MAl L SUCH NOTte E SHALL IMPOSE NO OBLIGATIO N OR LIABILITY
ACORD 25 (2001/08)
@ACORD CORPORATION 1988
City of Clearwater
Certificate issued to City of Clearwater
Slapin-Lieb & Co.
02/19/2008
NAMED INSURED: MALCOLM PIRNIE:
Endorsements or Modifications as Applicable:
General Liability (CG 0001 12/07): l/A, 2, 3, 4, 5, 6
Automobile eCA 0001 10/01: (T, LA, NH, VA): l/B, 3, 4, S, 6
Automobile (CA 0001 03/06: All Other States): l/B, 3, 4, 5, 6
Excess Liability (71154 08/04): 7
OPERATIONS OF THE NAMED INSURED
l/A: If required by written contract or agreement, the certificate holder and the City of Clearwater are
included as additional insured, but only for work performed by the Named Insured per CG2010 (07/04) and
CG2037 (07/04) per copies attached.
l/B: If required by written contract or agreement, the certificate holder and the City of Clearwater are
included as additional insured, per CA 2048 (02/99) per copy attached~
2: Excludes Professional Liability
3: If required by written contract or agreement, includes Waiver of Subrogation~
4~ If required by written contract or agreement, this insurance is primary to the extent coverage is
provided by the policy for the Certificate Holder as respects work performed for the Certificate Holder
by the Named Insured.
5. If required by written contract or agreement, includes Contractual Liability
6~ If required by written contract or agreement, includes Separation of Insureds
7~ Policy is follow-form excess of General Liability and Automobile Liability policies except as respects
per project and per location aggregate lim;ts~
POl~CY NUMBER ~ GL 1633241
COMMERCIAL GENERAL LIABILITY
CG 20 10 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZA TION
T his endorsement modifies insu ra n ce provi ded under the foUowi n g:
COMMERCIAL GENERAL LtABllrTY COVERAGE PART
SCHEDULE
Where req uired by written contract
Location. Of Covered 0 rations
As required by written contract
A. Section II - Who Is An Insured '5 amended to
,nclude as an addihonaJ In s ured the pe rson ( 5) or
organization( s) 5 hown ~n the Sc hedu Je. but on Jy
with respect to Hab~hty for ubod.fy rnjury", "property
damage I. or II persona I a nd advert's I ng l nJ U ry-'
caused, in whole 0 r rn part, by
1. Your acts or OmJSSlons, or
2, The acts or omlss,ons of those acting on you~
beharf:
In the performance of YOUf o~gol ng operat'ons ~o~
the addttionaJ I nsured( s) at the locat1on( S J des 19'
nated above
CG 20 1 0 07 04
B. W;th respect to the tnsurance afforded to these
add'tlona' Insureds, the following additional exclu.
S tons app Iy
This Insurance does not apply to "bodHy InJury" or
"property damageU occurring after
1. AU work Jnc~udlng mater'als parts or equlp-
men1 furnIshed In connection wtth such worK
on the projecr (other than servfce. maIntenance
or repa~rs) to be performed by or on behalf of
fhe addItIonal ;nsured(s} at the tocalion of the
covered operations has been completed or
2. 1 hat portion of uyour work" Ol,;t of which the
Injury or damage anses has been put to Its rn-
tended use by any person or organlzat'on other
than another contractor or 5ubcontraclor en-
gaged In performing operaho.'1s for a pnncipal
as a part of the same project
(Q ~SO Properties Inc. 2004
o
Page 1 of 1
COMMERCIAL GENERAL
POL'CY NUMBER~ GL 163:)241 LIABILITY
CG 20 3707 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies in sura nee provided under the tollowi ng:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Ion.
CG 20 37 07 04
@ ISO Propertl.s. Inc., 2004
POLtCY NUMBER: CA1633242 & CA1633243
COMMERCIAL AUTO
CA 20 48 02 99
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
DESIGNATED INSURED
This endorsemen t mod ifies r nsu ran ce prov j d e d u nd er the foUowi n g:
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
With res pec I to coverage provided by Ihis e ndorsemen t. th e provi s;on s of the Coverage Form apply u nt ess
modified by this endorsement.
This endorsement identifies person{s) or organization{s) who are Ujnsuredsu under the Who Is An Insured Provi..
sion of the Coverage Form. Thi s endorsement does not a Iter cove rage prav; dad in the Coverage Form.
This endorsement changes the pol icy effective on the inception date of the poHcy un I ess a n other date i s ~n di-
cated below.
Endorsement E ffect;ve: 02/01/2008
CounterStg ned By.
Named Insured~ Malcolm Pirnie. Inc.
(Au thonzed R epresentat tve)
SCHEDULE
Nlme of Person(s) or Organization(s):
Where requ ired by written contract
Of no entry appears above. Informat~on requrred to complete thrs er'ldorsement w~1f be shown in the Dec'aratlons
as apphcable to the endorsement j
Each person or organi zatlon shown fn the Schedule is an l'j nsured" for Ll a bihty Coverage. but on Iy to the extent
that person or organizat;on Quahf1es as an "Insured" under the Who ts An Insured Provis~on contained
in Section II of the Coverage Form
CA 20 48 02 99
Cop yrig h t r Ins u ranee Services Office, ~ nc. , 1998
Page 1 of 1
o
IMPORTANT
If the certificate hol der is a n ADO fT 10 NA L INS U RED 1 the pol i cy( j es) must be end orsed. A statement
on th i s certificate does not co nfer ri 9 hts to the certificate holde r in lie u of su ch end orsem ent( 5 ).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certa~n policies may
requ i re an endorse ment. A sta lament 0 n th i 5 certificate does not confer ri ghts to the certificate
hold e r in I ieu of such en dorse ment( s).
DISCLAIMER
The Certifi cate of I nsura nee on the reverse side of th i 5 form does not constitute a contract betwee n
the issuing insurer(s)t authorized representative or producer~ and the certificate holdert nor does it
affi rmatively or nag atively a men d, exte nd or alter the cove rage affa rded by the pol i cies listed th ereon .
ACORD 25 (2001/08)