CERTIFICATE OF LIABILITY INSURANCE (87)10/15/2008 10:40 7275624755 ENG PAGE 01
DATE PM
ACOR CERTIFICAtO OF LIABILITY INSURANCE i0
°'Y"'
10/08
/08/08
PRODUCER 1-866-220-4635 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Nolman Murphy and associates - om&ha ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
2637 South 156th Plaza ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 200
Omaha, NE 68130 INSURERS AFFORDING COVERAGE
NSURED INSURERA:zurich Americam Insurance #16535
Poet. Buckley, Schuh & Jernigan, inc.
d/b/a PBSEJ WWFIERB!Zurich American ;nsurance Company / #16535
2001 AN 107th Avenue MI8URERC'Steadf4L4t MASurance Campany/#26367
Miami, PL 33172-2507 INSURER Or
COVERAGE$
THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REdUIREMENT, 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.
YJBH TYPE OF MURAHCE POLICY NUMBR ?! BGTIV! POLICY MNIATION LIMITS
A GENERALLIABILTIY GLO 9139458-02 09/30/08 09/30/09 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY
_ FIRE DAMAGE An 2Mft 1,000,000.
F
1
CLAIMS MADE
OCCUR
x 1.722 GXP Ift ow person) $2S.000
X Contractual Liability PERSONAL dADVINJURY $1.000,000
GENERAL AGGREGATE $ 2,000,000
GEN'LAGGREGATE LIMIT AFPLIESPEm PRODUCTS -COMP/OPAGG $2,000,000
POLICY X X LOC
H AUT OMOBILE LIABILITY BA? 91394 09130100 09/30/09 COMBINED SINGLE LIMIT
X
ANY AUTO RECEIVE D
(Ea eacltlerM) $2,000,000
ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per pemm)
X HIRED AUTOS //++ p
0 CT Y I rJ
BODILY INJURY E
X
NON-OWNED AUTOS )
S Contractual Liability
C
P
PE
TY
OF t
ITY R R
DAMAGE
R
P
dd $
(
er ao
wd)
GARAGE LIABILITY ?'r 7 AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC S
AUTO ONLY! AGG 6
C UCESSLIA6ILITY AM 508765104 09/30/08 09/30/09 EACH COMMENCE $ 35,000,000
X OCCUR ? CLAIMS MADE AGGREGATE $25,000,000
S
DEDUCTIBLE
RETENTION 0 $
7? WORKBRS0OMPENSAT1oNAN0
W
' NC 9139459-02 09130108 09/30/09 X W03TATU 0TH6
AKOYERS
LIABILITY
E.L. EACH ACCIDENT
$1 , 000,000
E.L DISEASE - EA EMPLOY $1,020,000
E.L. DISEASE • POLICY LIMIT 1, 000, 000
OTHER
8
s
s
DESCRIPTION OF OPERATIONSILOCATIONWVEML KNM An= irf PROVISIONS
R8: City of Clearwater.
City of Clearwater is an Additional Insured 04 the general Liability and Butcmwbile Liability with respect to the
operations of the insured.
See attached for additional wording.
Clearwater, city of
>tgineer of Record
100 South Myrtle Avenue, 209i0*9ring - Suite 220
Clearwater, FL 33756
9NDULD ANY OF 7HE ABOVE DM"BED POUC= BE CANCRLLED BEFORE THE ®IPINAYION
DATE THEREOF, THE ISBUM INSURER YRLL MAIL 90 DAYS WRITTEN
NOTICE TO THE CER'1IFICATA HOLDER NAMED TO THE LKFT,
AUT1 PwRBSlNTAmE e ! i/...a
gandersoa
10025993 0 ACORD CORPORATION 1 888
10/15/2008 10:40 7275624755 ENG PAGE 02
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) 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 after the coverage afforded by the policies listed thereon.
ACOHD 25.8 (7/97)
10/15/2008 10:40 7275624755 ENG PAGE 03
DATE
SUPPLEMENT TO CERTIFICATE OF INSURANCE 10/08/08
NAME OF INSURED: Post, Buckley, Schuh & Jernigan, XIW-
I 8/b/s HeS&J
Additional insured on the General Liability & Aato Liability on a Primary & Non-Contributory basis, including
completed operations d'Where Required by contract" (OL ONLY). peaerai Liability Aggregate limit applies per Project
Blanket Additional Insured Lessor/Loss Payee on the Auto Liability. waiver of Subrogation on the General Liability
Auto Liability, and Workers Comppensation "Where Required by Contract*. Umbrella follWo torn to the Additional
Insureds on the General Liability.
NOTxCR OF CANCELLATION WHIM:
szouLD ANY OF TES a88CRxMM POLICIES ON TSE C'.SRTSHICAT>R an CLNCBLLED BEFORZ TIM $TPTRATION DATE THEREOF, THE
ISSUING INSURER W%U MAIL 90, 60 OR 90 DAYS NEXT "lS[T NOTICE •pmmg REQUIRED BY CONTRACT" EXCEPT 10 DAYS NOTICE FOR
NON-PAYMUT OF PREMUK TO TEE CSRTiBSCAT3 HOLDER IUUM ON THE ATTACURD CERTIFICATE.
10/17/2008 13:33 7275624755 ENG PAGE 03
Ai
CERTIFICATE OF LIABILITY INSURANCE IMMIDDA-rM
DA
m
9/30/2009 10/8/2008
PRODUCER LocktOn Companies, LLC-1 Kansas City THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
444 W. 47th Street, Suite 900 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Kansas Cit MO 64112-1906 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
(816) 960-9000 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC #
INSURED POST, BUCKLEY, SCHUH AND JERNIGAN, INC. INSURER A : LLOYDS OF LONDON A Xv
1307320 DBA PBS&J
2001 NW 107 AVENUE INSURER B
MIAMI FL 33172-2507 INSURER C :
INSURER D :
INSURER E :
COVERAGES ??} T 1119 CERIIFICATE F INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING
I N AUTHORIZED T CERTIF CATE HOLDER
.
THE POLICIES OF INSURANCE; U$TCD 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 I$SUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECY TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INS[Y ADO L POLICY EFFECTIVE POLICY EXPIRATION
LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE MMJDO DATE (MMIDOW) LIMITS
GENERAL LIABILITY EACH OCCURRENCE S xxxxxxx
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENT-ED
PREMISES Ea o=urencal
E XXXXXXX
CLAIMS MADE E] OCCUR NOT APPLICABLE MED EXP Any one person S xxxx =
PERSONAL & AOV INJURY $ xx)cx) [X
_ GENERAL AGGREGATE S xxx7'=
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMROP AGO S XXXYXXX
PRO-
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S xxxxxxx
ANY AUTO (Ea axidere)
ALL OWNED AUTOS BODILY INJURY
P S XXXXX3CX
SCHEDULED AUTOS NOT APPLICABLE e( person)
(
HIRED AUTOS BODILY INJURY
P
d
t $ xxxxxx C
NON-OWNED AUTOS (
er acci
en
)
VV ?? PROPERTY
AMAGE
G1 ,v'? j
(Per a?eM $ )X
xxxxx
X12
GARAGE LIABILITY "G\ AUTO ONLY - EA ACCIDENT S xxxxxxx
NOT APPLICABLE
ANY AUTO OTHER THAN E,AACC 8 XXXXXXX
AUTO ONLY: AGG $ XXXXXXX
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S xxxxxxx
OCCUR D CLAIMS MADE AGGREGATE S xxxxx x
NOT APPLICABLE
0 UMBRELLA $ )Q XXXXX
DEDUCTIBLE FORM S xxxxxxx
RETENTION 8 ..Y. XxxxX.XX
WORKERS COMPENSATION AND
EMPLOY
' STATU-
IMITS TyRli-
FKS
LIABILITY
ANY PRDPRIETORlPARTNERIEXECUTIVE
NOT APPLICABLE
El. EACH ACCIDENT
$ xxxxxxx
OFFICEP MEMseR EXCLUDED?
It yes, 0R&4c vndcr
E. L. DISEASE - EA EMPLOYEE
$ XXXxxxx
SPECIAL PROVIBICNS tglpw E.L. DISEASE, POLICY LIMIT $ XXXXXXX
A
A OTHER LeDUSA0800811 91301'2008 9/30/2009 s1,000 000 EACH CLAIM & $1,000,000
CLAIMS-MADE FORM AAW
L
PROFESSIONAL/POLLUnON ?
RE'IRODATS.
LIABILITY
DESCRIPTI ON OF OPERATIONSILOCATIONSAIEHICL ES/EXCLUSONS ADbEC BY ENDORSEY EAIT/SPECIAL PRravLR lriNs
RE: CITY OF CLEARWATER.
CLEARWATER, CITY OF
ENGINEER OF RECORD
100 S. MYRTLE AVENUE
ENGINEERING - SUITE 220
CLEARWATER FL 33756
SHOULD ANY OF THE ABOVE DESCRIBED POLICN5 BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CER'nFIOATE 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
ACORD 26 (2001108) For gvWj"q Ieoardinp INS ce,tifiaels, eaNect the numeee I.&d 1n" Producer ¦eceon ebav..
B' ACORD CORPORATION 1988