CERTIFICATE OF LIABILITY INSURANCE (85)I• t# 6108
GRIMCRA3
C on
ACORDTM CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD1YYYY)
PRODUCER
Suncoast Insurance Associates
P.O. Box 22668 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.
Tampa, FL 33622-2668
813 289-5200
INSURERS AFFORDING COVERAGE
NAIC #
INSURED INSURER A: Phoenix Insurance Company 25623
l Crawford, Inc.
Gri INSURER B: Travelers Casualty and Surety Co 19038
1511 N
Westshore Blvd INSURER c: Hudson Insurance Company 25054
Suite 1115
Suite INSURER D:
Tampa, FL 33607 INSURER E:
I Wv-_-
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
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
MAY PERTAIN
,
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR DD
NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE
DA E MMIDD POLICY EXPIRATION
DA (MM/DDffY1 LIMITS
A GENERAL LIABILITY 68052BOL540 10/14/08 10114/09 EACH OCCURRENCE $2 000 000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
o .. Fa ? currence%
$1 000.000
_ CLAIMS MADE 7 OCCUR MED EXP (Any one person) $1 O 000
PERSONAL & ADV INJURY $2,000,000
GENERAL AGGREGATE $4 OOO 000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s4,000,000
POLICY PRO LOC
JECT
AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
/? '
ALL OWNED AUTOS / EIV BODILY INJURY
$
SCHEDULED AUTOS gyp' (Per person)
HIRED AUTOS n BODILY INJURY
$
NON-OWNED AUTOS 2008
` ? - (Per accident)
PROPERTY DAMAGE $
f L RE
(Per accident)__
GARAGE LIABILITY - GiS TIVE SRVC5 EP AUTO ONLY-EA ACCIDENT $
T
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE - $
OCCUR FICLAIMS MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ - $
B WORKERS COMPENSATION AND UB610OY759 05/22/08 05122/09
IT Y WC I IMIT O_R
X
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
E.L. DISEASE - EA EMPLOYEE
$1,000,000
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
$1,000,000
C OTHER Professional AEE7137103 05/29/08 05/29/09 $2,000,000 per claim
Liability $2,000,000 annl aggr.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Professional Liability is written on a claims made and reported basis.
RE: City of Clearwater Engineering of Record
City of Clearwater
Engineering Dept. Ste. 200
Attn: Susan Chase
PO Box 4748
Clearwater, FL 33758-4748
LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _30_ DAYS WRITTEN
E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
SE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUJIJORIZED ' REPRESEjdTATIVE
;V
ACORD 25 (2001/08) 1 of 2 #M173199 KHK 0 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 25S (2001/08) 2 of 2 #M173199