CERTIFICATE OF LIABILITY INSURANCEMARSH USA. INC.
1166 AVENUE OF THE AMERICAS
NEW YORK, NY 10036
ATTN: NEWYORK.CERTS@MARSH.COM
011046
CITY OF CLEARWATER
FINANCE DEPARTMENT M-011046
ATTN: CAROL BARDEN
100 S MYRTLE AVE
CLEARWATER FL 33756-5520 100
018466
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.
Oe.,o.ce -F 0- 4
ACORD_ CERTIFICATE OF LIABIL DATE (MM/DD/YYYY)
ITY INSURANCE
10/01/2008
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1166 Avenue of the Americas HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
New York, NY 10036 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Attn: NewYork.Certs@Marsh.Com Fax 212-948-0500
i
109513-ALL-CAS-08-09 INSURERS AFFORDING COVERAGE NAIC #
I- ... - - ---- . ...
INSURED - -- --- - --
INSURERA Federal Insurance Company
20281
PRICEWATERHOUSECOOPERS LLP
300 MADISON AVENUE
NEW YORK, NY 10017 INSURER B Pacific Indemnity Co
INSURERQ 20346
! INSURER D' ---__-_--
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.
NS
LTR ADD'y
INSRq TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE
DATE (MM/DDIYY) IPOLICY EXPIRATION
I DATE (MM/DD/YY) ( - LIMITS
!
A GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
7350-83-15
09/30/08
09/30/09 I EACH OCCURRENCE _
DAMAGE TO RENTED
PREMISES(Ea occurenc_) 1,000,00q
$
CLAIMS MADE OCCUR
EX I MED EXP (Anyone person)- $ - 1-,00
PERSONAL R ADV INJURY $ 1,000,00
GENERAL AGGREGATE $ 2,000,00
GENERAL AGGREGATES LIMIT APPLIES PER PRODUCTS - COMP/OP AG $ 1,000,00C
POLICY JECT LOC
A AUT OMOBILE LIABILITY
ANY AUTO 7497-74-17 09/30/08 09/30/09
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,00
ALL OWNED AUTOS BODILY INJURY $
SCHEDULED AUTOS (Per person)
X HIRED AUTOS
BODILY INJURY
$
X NON-OWNEDAUTOS ! (Per accident)
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILIT Y AUTO ONLY - EA ACCIDENT $
ANY AUTO T r'? HER THAN EA ACC
F $
?
. L
ZUUB AITO
ON LY: $
, AGG
1 EXCESS/UMBRELLA LIABILITY
OCCUR CLAIMS MADE e
OFFICIA
RECORDS ?
IV? EACH OCCURRENCE
AGGREGATE $
Is
LEGISL IVE SRVCS D Pj' $
DEDUCTIBLE
$
RETENTION $
B WORKERS
EMPLOYE COMPENSATION AND
RS'LIABILITY 7170-68-12 09/30/08 09/30/09 X WC STATU- OTH-
TnRV IMI
FR
$ 2
000
00
L. EACH ACCIDENT
IDENT ,
,
- ANY PROPRIETORIPARTNER/EXECUTIVE
,.OFF.IC,ER/MEMBE.R.EXCLUUED9.X._._.. ...._,.._.
_?_.,_...?..._.._._-.- .,.._._._ .-.-__.
_ __ ..
._..__... .._
.-8 ASE
:..MPLL?fi
$.-_..._ -2;000,'
If yes, describe under ____
DISEASE -POLICY LIMIT
E
L
$ 2
000
00
SPECIAL PROVISIONS below .
. ,
,
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCWSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
L_
CERTIFICATE HOLDER NYC-003005823-08 CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CITY OF CLEARWATER EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
FINANCE DEPARTMENT 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
ATTN: CAROL BARDEN
100 S. MYRTLE AVE.
CLEARWATER, FL 33756 BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND
UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
402USA19SENTATIVE
Jennifer Ellefsen
AUUKU -LS (-LUU7/US) o ACORD CORPORATION 1988