CERTIFICATE OF LIABILITY INSURANCE (76)
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY)
OS/29/08
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Suncoast Insurance Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 22a58 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tampa. FL 33622-~8
813289-5200 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Phoenix Insurance Company 25623
Grimail Crawford, Inc. INSURER B: Travelers Casualty and Surety Co 19038
1511 N Westshore Blvd INSURER C: Hudson Insurance Company 25054
Suite 1115 INSURER D:
Tampa, FL 33607 INSURER E:
Client#. 6108
GRIMCRA3
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.
'CT'"; ';JS~[ TYPE OF INSURANCE POLICY NUMBER PJ>A~~~:~~~m\E P%~fJ (If"X,,\;~~reN LIMITS
A ~NERAL LIABILITY 6805280L540PHX07 10/14/07 10/14/08 EACH OCCURRENCE $2 000 000
X COMMERCIAL GENERAL LIABILITY g~!'!1~~IEORENTED $2.000 000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $5.000
- PERSONAL & ADV INJURY $2 000 000
,-- GENERAL AGGREGATE $4 000 000
n'L AGGREAE LIMIT APPlS PER: PRODUCTS - COM PlOP AGG $4 000 000
POLICY j~8T LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
-
f-- ALL OWNED AUTOS J 1N BODILY INJURY
03 2008 $
SCHEDULED AUTOS (Per person)
I--
- HIRED AUTOS BODILY INJURY
". $
NON-OWNED AUTOS 1;..;: 'U)l'.;'''' (Per accident)
- l ")
PROPERTY DAMAGE
'. o. r (Per accident) $
RAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
~ESS/UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR D CLAIMS MADE AGGREGATE $
$
...... ~Di:'DUCT~BLE . - $
-_.---- - . =. ...... ... .
RETENTION $ $
B WORKERS COMPENSATION AND UB6100Y75908 OS/22/08 OS/22/09 X T WCSTATU-T IOJ~-
EMPLOYERS' LIABILITY $1 000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1 000,000
If yes. describe under $1 000,000
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT
C OTHER Professional AEE71371-03 OS/29/08 OS/29/09 $2,000,000 per claim
Liability $2,000,000 annl aggr.
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Professional liability is written on a claims made and reported basis.
RE: City of Clearwater Engineering of Record
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ---3.0.- DAYS WRITTEN
Engineering Dept. Ste. 200 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
AUn: Susan Chase IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
PO Box 4748 REPRESENTATIVES.
Clearwater, FL 33758-4748 A~ED REPR~TIVE
. ~ Ql.., .4J. ~
ACORD 25 (2001/08) 1 of 2
#M166004
BPK
@) ACORD CORPORATION 1988
-~
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 25-5 (2001/08) 2 of 2
#M166004