CERTIFICATE OF LIABILITY INSURANCE (63)
/ I
ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY)
07/28/08
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Suncoastlnsurance 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: Old Dominion Insurance Company 40231
Robert Aude Associates Inc AlA INSURER B: Travelers Indemnity Company 25658
19353 U.S. Hwy 19 N INSURER C: Travelers Casualty and Surety Co 19038
Ste 101 INSURER D: XL Specialty Insurance Company 37885
Clearwater, FL 33764 INSURER E: Charter Oak Fire Insurance Company 25615
Client#. 3206
AUDEROB3
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.
INSR ~~~~ TYPE OF INSURANCE POLICY NUMBER PJ>k~fY EFFECTIVE POLICY EXPIRATION LIMITS
LTR E IMM/DDIYVI- DATE IMM/DDIVYI
A GENERAL LIABILITY BPG98417 07/22/08 07/22/09 EACH OCCURRENCE $1 000000
f--
JL COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED ne~\ $500.000
f-- :J CLAIMS MADE [K] OCCUR MEDEXP (Anyone person) $5 000
f-- PERSONAL & ADV INJURY $1.000.000
f-- GENERAL AGGREGATE $2 000 000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COM PlOP AGG $2.000.000
Ii nPRO- n
POLICY JECT LOC
E ~TOMOBILE LIABILITY BA2951L75208 08/07/08 08/07/09 COMBINED SINGLE LIMIT
~ ANY AUTO (Ea accidenl) $1,000,000
f-- ALL OWNED AUTOS , )EC.EfVE l) BODILY INJURY
$
SCHEDULED AUTOS (Per person)
f--
~ HIRED AUTOS . UL 2 G 2008 BODILY INJURY
$
~ NON-OWNED AUTOS (Per accident)
f-- OFFle ~i RECtJRU$' PROPERTY DAMAGE $
NLJ (Per accident)
RRAGE LIABILITY .. . - SRVCS [ EP1 AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
B ~ESS/UMBRELLA LIABILITY CUP7113Y0951ND08 07/22/08 07/22/09 EACH OCCURRENCE $1 000000
X OCCUR D CLAIMS MADE AGGREGATE $1.000.000
$
~ DEDUCTIBLE $
X RETENTION $10000 $
C _WQRKERS~~MPENSATIO~AND U~7IUtOY38~__ ~_ --- Q.M)1108 _ Q,91iU L09 - X J T~~T~y'~; I j()J~- - -
EMPLOYERS' LIABILITY $500.000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $500,000
If yes, describe under E.L. DISEASE - POLICY LIMIT $500.000
SPECIAL PROVISIONS below
D OTHER Professional DPR9613711 07/20/08 07/20/09 $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 claims made and reported.
City of Clearwater is an additional insured w/respect to General Liability
and Auto Liability. Waiver of Subrogation is included except for Workers
Compensation.
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
P.O. Box 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Clearwater, FL 33758-4748 REPRESENTATIVES.
A~ED REPR~TIVE
.,.", Ql... .4J ~
ACORD 25 (2001/08) 1 of 2
#S169137/M169135
KEB
@ 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
#S169137/M169135