CERTIFICATE OF LIABILITY INSURANCEcuenta: 24(b HAKVJULs
ACORD,. CERTIFICATE OF LIABILITY INSURANCE
1
DATE (MMIDDIYYYY)
11/07108
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
Harvard Jolly, Inc. INSURER B: Travelers Casualty and Surety Co 19038
2714 Dr Martin Luther King Jr St N INSURER C: XL Specialty Insurance Company 37885
St Petersburg, FL 33704 INSURER D:
INSURER E:
nnVFRA['FR
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 POLICY EFFECTIVE
DATE MM/DD POLICY EXPIRATION
DATE MM/DD
LIMITS
A GENERAL LIABILITY 660-6514L487 11108/08 11/08/09 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY PRAMMGE TO RENTED occurrence)
CE, S1,000,000
CLAIMS MADE FRI OCCUR MED EXP (Any one person) $10,000
PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: ?G a J PRODUCTS - COMP/OP AGG s2,000,000
POLICY X PROECT LOC
J 4r
AUT OMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO
(Ea accident) $
ALL OWNED AUTOS q .
BODILY INJURY
SCHEDULED AUTOS
(Per person) S
HIRED AUTOS -
t" BODILY INJURY
NON-OWNED AUTOS ,? F a (Per accident) $ -
C
r
?N ER,N
PROPERTY DAMAGE
t?
G
(Per accident) $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S
ANY AUTO OTHER THAN EA ACC S
AUTO ONLY: AGG $
A EXCESSIUMBRELLA LIABILITY CUP-7798Y577 11/08/08 11/08/09 EACH OCCURRENCE $4,000,000
X OCCUR ? CLAIMS MADE AGGREGATE s4,000,000
S
H DEDUCTIBLE $
X RETENTION $ 10000 S
B WORKERS COMPENSATION AND UB5238Y87 01/01/08 01101/09 )( WCRY C LIMIT 0TH-
S _R
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$1 ,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1,000,000
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
S1,000,000
C OTHER Professional DPR9613427 06/30/08 06/30/09 $3,000,000 per claim
Liability $3,000,000 annl aggr.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Professional Liability is claims made and reported.
RE: City of. Clearwater
Certificate holder is listed as an additional insured with respects to the
General Liability policy.
ULK I IHUA I L HULUtK
City of Clearwater
Engineering Dept.
100 S. Myrtle Ave.
Clearwater, FL 33756
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 'In 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
AUTFjO. "J"L RESENTAT?e
ACORD 25 (2001/08) 1 Of 2 #M174921 KEB o 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 25-S (2001108) 2 of 2 #M174921