CERTIFICATE OF LIABILITY INSURANCE (92)10/27/2008 10:45 FAX 727 544 8842 BAY AREA INStTRANCE INC X1002/002
CERTIFICATE OF INSURANCE
The company indicated below certifies that the insurance afforded by the policy or policies numbtred and
described below is in force as of the effective date of this certificate. This CertiFicate of Irsurance
does not amend, extend, or otherwise alter the Terms and Conditions of Insurance coverage contaired in any
policy numbered and described below.
CERTIFICATE HOLDER: INSURED:
CITY OF CLEARWATER FOWLER ASSOCIATES ARCHITECTS
PO BOX 4748 1421 COURT STREET
CLEARWATER, FL 33758 SUITE D
CLEARWATER, FL 33756-6172
I POLICY NUMBER I POLICY I POLICY
TYPE OF INSURANCE I & ISSUING CO. JEFF. DATE IEXP. DATE
LIABILITY 1 77.80-778114.3001 J 03-25-08 J 03-25-09
[X7 Liability and I NATIONWIDE I I
LIMITS OF LIABILIT(
(*LIMITS AT INCEPTION)
Any One Occurrence........ $ 1,000,000
Medical Expense I MUTUAL I I I
Personal and I INSURANCE CO. I I Included in Above - Any One 'erson or 1
Advertising Injuryl I 1 Organization
[X1 Medical Expenses I J I I ANY ONE PERSON ........... $ 5,000 I
[X] Fire Legal I J I Any One Fire or Explosion $ 50.000
J Liability I I I I
I I I I General Aggregate* ....... $ 2,000,000
Prod/Comp Ops Aggregate* . $ 1.000,000 I
C] Other Liability I I I I
J
I AUTOMOBILE LIABILITY
[ ] BUSINESS AUTO 1 I I I Bodily Injury
I I I I I (Each Person) .......... $
C] Owned 1 I I I (Each Accident) ........ $
l C] Hired I I I I Property Damage J
[ ] Non-Owned I I I I (Each Accident) ........ $
Combined Single Limit .... $
I EXCESS LIABILITY J I I Each Occurrence .._....... S
I
[ I I
l 1 a Form
b
U rt?`," I Prod/Comp Ops/Disease
Aggregate* .......
$ J
I
J re
m
( ] I II ocl 31. QaO? I STATUTORY LIMI"S
Workers- I I BODILY INJURY/ACCIDENT ... $
Compensation 1 RECORDS AND 1 Bodily Injury by Disease
I and I OFF ='% pER[ I EACH EMPLOYEE .......... $
[ ] Employers' 1 LEPISWINE S ACS 1 Bodily Injury by Disease
Liability I I I I POLICY LIMIT ........... $
I -
Should any of the above described policies be cancelled before the DESCRIPTION OF OPERATIONS/LOCATIONS
expiration date. the insurance company will endeavor to mail VEHICLES/RESTRICTIONS/';PECIAL ITEMS
written notice to the above named certificate holder, but failure to
mail such notice shall impose no obligation or liability upon the
company, its agents, or representatives.
Effective Date of Certificate: 03-25-2008
Date Certificate Issued: 10-27-2008
Authorized Representative: Bay Area Insurance Inc
Countersigned at: 9067 BELCHER RifAD
PINELLAS PARK, FL 33782
i