CERTIFICATE OF INSURANCE (17)
~A CORD.. CERTIFICATE OF LIABILITY INSURANCE OP ID P11 DATE (MMIDDIYYYY)
CUMBE-2 04/08/04
PRODUCER '. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wallace Welch & Willingham Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
300 First Avenue South, 5 th Fl HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 33020 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
St. Petersburg FL 33733 -
Phone: 727-522-7777 Fax:727-521~2902 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Zurich Insurance Company
INSURER B CNA Insurance Companies 35270
Cumbet & Fair, Inc. INSURER c:
2463nterprise Rd. INSURER D:
Clearwater FL 33763
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
LTR NSR[ TYPE OF INSURANCE POLICY NUMBER PD~~~TJ~fJtf~!;'\E Pgk~~Y(ij~bRDA~~~N LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
- U "VlI-I"'t:"uI"<t:r lEU
A X COMMERCIAL GENERAL LIABILITY PAS42162868 03/16/04 03/16/05 PREMISES lEa occurence) $300,000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $10,000
PERSONAL & ADV INJURY $1,000,000
f-
GENERAL AGGREGATE $2,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS. COMP/OP AGG $2,000,000
-, n PRO~ nLOC Emp Ben. 1,000,000
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $
ANY AUTO (Ea accidenl)
-
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
f--
HIRED AUTOS BODILY INJURY
f- $
NON.OWNED AUTOS (Per accidenl)
f--
'-- PROPERTY DAMAGE $
(Per acc,dent)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $2,000,000
A ~ OCCUR 0 CLAIMS MADE PAS42162868 03/16/04 03/16/05 AGGREGATE $2,000,000
$
Fx=l DEDUCTIBLE $
X RETENTION $10000 $
WORKERS COMPENSATION AND I TORY LIMITS T rUIH.
ER
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E.L DISEASE. EA EMPLOYEE $
If yes, describe under E.L DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
B Professional Liab AEA1l4088327 02/19/04 02/19/05 1,000,000 Ea Claim
$25,000 Ded 1,000,000 Aggr
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
RE: Job No: 712B Project Name: General and Professional Liability. the City
of Clearwater is Additional insured with regard to General Liabili ty.
CERTIFICATE HOLDER
CANCELLA TION
CITY-CL
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DA YS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS DR
REPRESENTATIVES.
AUTHORIZE ESE
@ ACORD CORPORATION 1988
City of Clearwater Risk
Management
P.O. Box 4748
Clearwater FL 33758-4748
ACORD 25 (2001/08)