CERTIFICATE OF LIABILITY INSURANCE (12)
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CERTIFICATE OF LIABILITY INSURANCE
FAX (305)827-0585
Fowler, Dowling
I DATE (MM/DDIYYYY)
10/01/2005
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
.~.. INSURERS AFFORDING COVERAGE NAIC #
81 Jernigan, I.r~~ INSURER.A:. sen.try Insurance a Mutual COlllJan A+ XV
~'II? !! ~ INSURER B: Steadfast Insurance Company A XV
(!9- ~~E~ c: lloyds of london A XV
ItWUR~_ "
~ 0l'J'" I~ E/? ~
COVFRAGES I '- I A '/~'!
THE POLICIES OF INSURANCE LISTED BELOW HAVE B THE INS VE FOR THE POLlCY,PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CO NT DOCU ~SPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES E1N IS TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED S.
I~~: ~~'i~ TYPE OF INSURANCE POLICY NUMBER Y'l!l'FECtlJE POLICY EXPIRATION
PRODUCER (305)822-7800
Collinsworth, Alter,
" French Group Inc.
P. O. Box 9315
Miami lakes, Fl 33014-9315
INSURED Post, Buckl ey, Schuh,
d/b/a PBS8IJ
2001 NW 107 Avenue
Miami, Fl 33172-2507
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
I CLAIMS MADE [K] OCCUR
X Contractual l iab
-
90-15807-03 0
/
5
09/30/2006
LIMITS
$
$
MED EXP (Anyone person) $
PERSONAL & ADV INJURY $
$
PRODUCTS - COMP/OP AGG $
EACH OCCURRENCE
DAMAGE TO RENTED
1,000,000
1,000,000
25,000
1,000,000
2,000.000
2,000,000
A
GENERAL AGGREGATE
A
-
GEN'L AGGREGATE LIMIT APPLIES PER:
I POLICY [Xl ~r8T m LOC
AUTOMOBILE LIABILITY
X ANY AUTO
-
X ALL OWNED AUTOS
-
SCHEDULED AUTOS
-
X HIRED AUTOS
-
X NON-OWNED AUTOS
--
X Contractual l iab
-
90-15807-04 09/30/2005 09/30/2006 COMBINED SINGLE LIMIT
90-15807-05 (Ea accident) $ 1,000,000
BODILY INJURY $
(Per person)
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE $
(Per accident)
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACC $
AUTO ONLY: AGG $
AUC508762101 09/30/2005 09/30/2006 EACH OCCURRENCE $ 25,000,000
AGGREGATE $ 25,000,000
$
$
$
B
GARAGE LIABILITY
=i ANY AUTO
EXCESS/UMBRELLA LIABILITY
tKJ OCCUR D CLAIMS MADE
h DEDUCTIBLE
m RETENTION $ (J
NO
lDUSA0500811 09/30/2005
09/30/2006
09/30/2006 X I WC STATU- I 10J~-
E.L. EACH ACCIDENT $ 1 , 000 , 000
E.L. DISEASE - EA EMPLOYEE $ 1 , 000 , OO(J
E.L. DISEASE - POLICY LIMIT $ 1 000, OO(J
$1,000,000 limits
Ea Claim and Annual Aggregate
11/11/1961 Retrodate
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
A ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERlMEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
OTH~
Proress i ona 1/
C Pollution liability
90-15807-01 09/30/2005
90-15807-02
ClAIMS-MADE FORM
~DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
~ef: City of Clearwater.
~ertificate Holder is named as additional insured on the General " Auto
)rofessional services.
liability, excluding
C
Clearwater, City of
Engineer of Record
100 S. Myrtle Avnue
Engineering - Suite 220
Clearwater, Fl 33756
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
...lL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE lEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHAll IMPOSE NO OBLIGATION OR LIABILITY
-.- . ---" ---
---".-.--. ---
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATNE
..fl:/~~M/
Meade Collinsworth/EEC
ACORD 25 (2001/08)
@ACORD CORPORATION 1988