CERTIFICATE OF LIABILITY INSURANCE
Client#: 3970 JONEEDM3
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYVY)
06/30/08
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Suncoast Insurance Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 22668 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tampa, FL 33622-2668
813289-5200 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Travelers Indemnity Company of CT 25682
Jones Edmunds & Associates, Inc. INSURER B: Travelers Indemnity Company 25658
: 730 N.~. Waldo Road INSURER c: Travelers Casualty and Surety Co 19038
Gainesville, FL 32641 INSURER D: XL Specialty Insurance Company 37885
INSURER E: Travelers Indemnity Co of America 25666
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 PJ>.k{~~:~~~8tW1E P~~flr~~~~N LIMITS
A GENERAL LIABILITY 6801951L902 06/30/08 06/30/09 EACH OCCURRENCE $1 000000
---'- DAMAGE TO RENTED
X cor,IMcRCIAL GENERAL LIABILITY $1 000000
I CLAIMS MADE [K] OCCUR MED EXP (Anyone person) $5 000
PERSONAL & ADV INJURY $1 000000
-
GENERAL AGGREGATE $2 000 000
-
~'L AGGREnE LIMIT APPlS PER: PRODUCTS - COMP/OP AGG $2 000 000
PRO-
POLICY JECT LOC
E AUTOMOBILE LIABILITY BA1958L731 06/30/08 06/30/09 COMBINED SINGLE LIMIT
- $1,000,000
~ ANY AUTO (Ea accident)
ALL OWNED AUTOS W .~c.r{\ltr BODILY INJURY
- .r- '. ;.' '. '. (Per person) $
SCHEDULED AUTOS
~ ,
X HIRED AUTOS I' L 02 2008 BODILY INJURY
- $
~ ...l...... (Per accident)
NON-OWNED AUTOS
- OFF1C:A " RECORDS Ai D PROPERTY DAMAGE $
,;.- (Per accident)
~RAGE LIABILITY 11.1:\:1/;)1.)'\ IVt ::SI<Vl,;::i LJEI ~T AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
B EXCESS/UMBRELLA LIABILITY CUP6513Y228 06/30/08 06/30/09 EACH OCCURRENCE $5 000 000
~ OCCUR 0 CLAIMS MADE AGGREGATE $5 000 000
$
~ DEDUCTIBLE $
X RETENTION $ 10000 $
C WORKERS COMPENSATION AND UB6423Y038 06/30/08 06/30/09 X I WCSTATU- I 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
D OTHER Professional DPR9613436 06/30/08 06/30/09 $5,000,000 per claim
Liability $5,000,000 annl aggr.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Professional Liability is written on a claims made and reported basis.
2006 Engineer of RecordCertificate holder is listed as an additional
insured with respects to the
(See Attached Descriptions)
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 --30..- DAYS WRITTEN
Attn: City Clerk NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
POBox 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Clearwater, FL 33758 REPRESENTATIVES.
A~ED REPR~TIVE
',.". QL... .JQ ~
ACORD 25 (2001/08) 1 of 3
#M167534
MRL
@ 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 3
#M167534
ES~~liPmrtIONS'(Continued .frgm .Pag~ii~i)
General Liability and automobile policies.
., -'
#M167534