CERTIFICATE OF LIABILITY INSURANCE (13)
ACORD.. CERTIFICATE OF LIABILITY INSURANCE OP ID B~ DATE (MM/DDIYYYY)
WADET-B 10/05/05
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Professional Underwriters, Ine HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 3139 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Farmdngton Hills, MI 48333
Phone:248-855-3322 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Charter Oak ~ir. Insurance Co.
INSURER B: Traveler. property Casualty
Wade Trim, Ine. INSURER C: Caotinental Casualty CompBAY 20443
4919 Memorial Hwy., Suite 200 INSURER D:
Tampa, FL 33634 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 ~ DATEIMM/~ LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
-
A X X COMMERCIAL GENERAL LIABILITY 630-9921B797 ]0/01/05 - 10/01/06 pREtlisM ~~=~nce) $ 1,000,000
l CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 10,000
- PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
-
GEN'L AGGRETxE LIMIT APPLIES PER: PRODUCTS-COM~OPAGG $2,000,000
I XPRO-n
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
e-- $ 1,000,000
A ~ ANY AUTO 8l0-9921B797 10/01/05 10/01/06 (Ea accident)
ALL OWNED AUTOS BODILY INJURY
e-- $
SCHEDULED AUTOS (Per person)
-
HIRED AUTOS BODILY INJURY
- $
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
=i ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $14,000,000
B ~ OCCUR o CLAIMS MADE CUP-9921B797 10/01/05 10/01/06 AGGREGATE $14,000,000
$
=i DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X I TORY LIMITS T IU~~-
B EMPLOYERS' LIABILITY UB-9921B797 10/01/05 10/01/06 $500,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 500,000
If ~es. describe under
S ECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $500,000
OTHER
C ARCH/ENG PROF LIAB ABA 1333326027 10/01/05 10/01/06 EA. CLAIM 5,000,000
CLAIMS MADE BASIS DIID. AS S'1'ATIID 011 POLICY AGGREGATE 10,000,000
DESCRIPTION OF. OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
PROJECT NAME: 5~YBAR ENGINEBR OF RECORD CONTRACT.THE CERTIFICATE HOLDER IS
NAMED AS AN ADDITIONAL INSURED WITH RESPECT TO THE GENERAL LIABILITY.
CITY OF CLEARWATER,
ATTN: GLEN BARNICK
P.O. BOX 4748
CLEARWATER, FL 33758
CANCELLATION
CLEARWA 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
REPRES NTATlVES.
CERTIFICATE HOLDER
@ ACORD CORPORATION 1988
ACORD 25 (2001/08)