CERTIFICATE OF LIABILITY INSURANCE (2)
ACORD'M CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY)
5/1/2008
PRODUCER (727) 391-9791 FAX: (727) 39~ived THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Stahl & Associates Insurance, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
110 Carillon Parkway Miff 0 II 1008 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
St. Petersburq FL 33716 Cltv Manager's INSURERS AFFORDING COVERAGE NAIC#
INSURED Marquesas, LLC INSURER A: Amerisure Mutual Ins Co
JMC Development Corp. INSURER B:
2201 4th St N, Suite 200 INSURER c:
INSURER D:
St Petersburg FL 33704 INSURER E:
C
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 DESCRIBE~I~EREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AG REGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PA CLAIMS.
INSR ADD'L P~.k+~~i~fgg;W~ Pg~fl,~J;~~N LIMITS
TYPE OF INSURANCE POLICY NUMBER
~NERAL LIABILITY EACH ,.,"'" 'RREN('!= $ 1,000,000
X COMMERCIAL GENERAL LIABILITY ~~~~~H9E~~~J~~nce) $ 300,000
A I CLAIMS MADE ~ OCCUR GL2027887 5/1/2008 5/1/2009 MED EXP IAnv one nerson) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GENEI>AL AGGREGATE $ 2,000,000
~'L AGGRE@E LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000
X PRO- n
POLICY ECT LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
~ ANY AUTO (Ea accident)
A ALL OWNED AUTOS CA2027550 5/1/2008 5/1/2009 BODILY INJURY
- r-- r;.:~... $
SCHEDULED AUTOS if" Fp (Per person)
'-- ~--.
I-- HIRED AUTOS . ,.' 1/ ....,!.....;; BODILY INJURY
I~AY 06 20a ,. (Per accident) $
-- I-- NON-OWNED AUTOS
- PROPERTY DAMAGE $
, (Per accident)
~GE LIABILITY Lr I.L RECORDS AUTO ONLY - EA ACCIDENT $
ANY AUTO ,I, if. SRI/! I " C' OTHER THAN EA ACC $
. CSD PT AUTO ONLY: AGG $
EXCESs/UMBRELLA LIABILITY $
~ OCCUR D CLAIMS MADE AGGREGATE $
~~~=Es/._ . $
$
.-" -. --",- -. . :.-- --- .. 1$--
A WORKERS COMPENSATION AND X I Tvxr,~T~I,~" I OJ~-
EMPLOYERS' LIABILITY 500,000
ANY PROPRIETOR/PARTNERlEXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? WC1385656 5/1/2008 5/1/2009 E.L. DISEASE - EA EMPLOYEE $ 500,000
If yes, describe under 500,000
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATlONS/LOCATlONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate Holder is listed as additional insured with respects to General Liabili ty ATIMA
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City Of Clearwater EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
City Manager 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
PO Box 4748 -
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
Clearwater, FL 33758-4748
INSURER,ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ~~ ~
Kelly Petzold/GREEN ~~~
ACORD 25 (2001/08)
INS025 (0108)08a
@ ACORD CORPORATION 1988
Page 1012
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this
certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing
insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively
amend, extend or alter the coverage afforded by the policies listed thereon.
---
-~--~lc---
ACORD 25 (2001/08)
INS025 (0108).08a
Page 2 of 2
A CORD_ CERTIFICATE OF LIABILITY INSURANCE OPID AS I DATE(MMIDDIYYYY)
.. JMCDE-1 05/05/08
PRODUCER yea THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wallaoe Welch & Willingham Ino ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
~~g. Fi~:t 3~~~ue South, 5th Fl MAY 06 1008 ~~:~1H2b~~~~~cN~~~~~ ~~\~~NJ>LI~J:=~L~~.
St. Petersburg FL 33733 ~itv M '\H
Phone: 727-522-7777 Fax: 727-521-=2!102,anager S 0.. ~URERS AFFORDING COVERAGE NAIC #
INSURED
INSURER A
INSURER B
INSURER C:
INSURER 0:
INSURER E
Everest Indemnity Insurance Co
MarCRlesas LLC &
J.MC~esi~ & Develo~ent Ino.
2201 4th Street N, -.200
St. Petersburg FL 33704
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 NiiRi: TYPE OF INSURANCE POLICY NUMBER ~ DATE IIIMID~ LIMITS
GENERAL UABlUTY EACH OCCURRENCE $
f--
COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) $
I CLAIMS MADE D OCCUR MED EXP (Anyone person) $
~--_.>..'.. ". ,,-' .... .' '- ---- -.------- ---..- - ---- . PERSONAC& ArJV TNJURY . $ .. ,--'
.. f--
GENERAL AGGREGATE $
f--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COM~OPAGG $
n n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABlUTY COMBINED SINGLE LIMIT
f-- $
ANY AUTO (Ea accident)
f--
ALL OWNED AUTOS ~~" r-- ~ ~~... ,t~'- BODILY INJURY
f-- $
SCHEDULED AUTOS " (Per person)
f--
HIRED AUTOS BODILY INJURY
f-- V 062008 $
NON-OWNED AUTOS MJ (Per accident)
f--
f-- PROPERTY DAMAGE $
. Ie::: IX [ (Per accident)
GARAGE LIABILITY L: . i, SRVCS Of T AUTO ONLY - EA ACCIDENT $
R ANY AUTO "
OTHER THAN EAACC $
AUTO ONLY: AGG $
EXCESSlUMBRELLA LIABILITY EACH OCCURRENCE $10,000,000
A g] OCCUR D CLAIMS MADE 71C9000028081 05/01/08 05/01/09 AGGREGATE $10,000,000
over: $GL
R DEDUCTIBLE $ Auto
RETENTION $ $EL
WORKERS COMPENSATION AND I TORY L1Mm; I IUE~-
EMPLOYERS' UABlUTY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
.- ~~~M:t~~6Jt~1~~s belOw .- . -' -, --~ ~ .. ---- --,-.-. ~ . --
E.L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certifioate holder is listed as additonal insured with respeots to General
Liability ATIMA.
CERTIFICATE HOLDER
Ci ty of Clearwater
City Manager
PO Box 4748
Clearwater FL 33758-4748
CANCELLATION
CITCL-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS 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 OR
REPRESENTATIVES.
AUTH D SE E
@ACORDCORPORATION1988
ACORD 25 (2001/08)
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001/08)