CERTIFICATE OF LIABILITY INSURANCE (81)
AC9RD_ CERTIFICATE OF LIABILITY INSURANCE OP 10 ET I DATE (MM/DDNYYY)
BAKEBAR 08/29/08
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
J Rolfe Davis Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 4927 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Orlando FL 32802-4927
Phone: 407-691-9600 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Hartford Casual ty Insurance Co 29424
INSURER B: Zurich North American
Baker Barrios Architects, Inc. INSURER C:
189 s. Oran~e Avenue,Ste #1700 INSURER D:
Orlando FL 2801
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 PD'iLf~lri~rJ~~E P8k~CEY(~~/bDiYYj . LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
-
A X COMMERCIAL GENERAL LIABILITY 21SBA UF6297 11/15/07 11/15/08 PREMISES (Ea occurence) $ 1000000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 10000
PERSONAL & ADV INJURY $ 1000000
-
GENERAL AGGREGATE $ 2000000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2000000
I .n PRO- rxl
POLICY JECT X LOC .-.. --~- ,- '>''' ". ....,
~ fC: \.... r:. J V [ ~ ,-
AUTOMOBilE LIABiliTY COMBINED SINGLE LIMIT
- $
ANY AUTO (Ea accident)
- ~::7' 03 2006
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
HIRED AUTOS Of!-i- =i;>.L j?tCORm ANn BODILY INJURY
~ $
NON-OWNED AUTOS lEG I u\T1VE- SRVCS DEPT (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE liABiliTY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5000000
A ~ OCCUR D CLAIMS MADE 21SBA UF6297 11/15/07 11/15/08 AGGREGATE $ 5000000
$
::=l DEDUCTIBLE $
X RETENTION $10000 $
WORKERS COMPENSATION AND X ITO~v"LI~:i'S I IOJ~-
B EMPLOYERS' lIABILITY WC0253005501 09/01/08 09/01/09 $ 500000
ANY PROPRIETORlPARTNERlEXECUTIVE E:l. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E:l. DISEASE - EA EMPLOYEE $ 500000
If yes, describe under - ,.Ecl.-'*SEASE - POLICYUMff $500000- .
."" -SPECIAL PROVISIONS below- " ---".-"'-- -'-'~' ---" . ';--,---- "
OTHER
DESCRIPTION OF OPERATIONS IlOGA TIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER
City of Clearwater
Attn: City Clerk
POBox 4758
Clearwater FL 33758
CANCELLATION
CITYCLE 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
REPRESENTATIVES.
REPRESENTATIVE
@ACORDCORPORATION 1988
ACORD 25 (2001/08)
f
- ..
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.
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ACORD 25 (2001/08)