CERTIFICATE OF LIABILITY INSURANCE (94)Client#- 9476
HARVJOL3
ACORQ„ CERTIFICATE OF LIABILITY INSURANCE 10/29/2008 ""'
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 Indemnity Company 25658
2714 Dr Martin Luther King Jr St N INSURER c: Travelers Casualty and Surety Co 19038
St Petersburg, FL 33704 INSURER D: XL Specialty Insurance Company 37885
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.
LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
A GENERAL LIABILITY 66065141-487 11/08/07 11/08108 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGMISE E TO RENTED $300,000
CLAIMS MADE Fx? OCCUR MED EXP (Any one person) $5,000
PERSONALS ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OPAGG $2,000,000
POLICY X P C LOC .
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS ?of1Q (Per person) $
r(
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS
h
kl
C (Per accident) $
,
C(JR?
-
2 PROPERTY DAMAGE
u '' (Per accident) $
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
B EXCESS/UMBRELLA LIABILITY CUP7798YS77 11/08/07 11/08/08 EACH OCCURRENCE $4,000,000
X OCCUR 1-1 CLAIMS MADE AGGREGATE s4,000,000
DEDUCTIBLE $
X RETENTION $ 10000 $
C WORKERS COMPENSATION AND UB5238Y87 01/01/08 01/01/09 X WCSTATU- CER
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
$1,000,000
D OTHER Professional DPR9613427 06/30/08 06/30/09 $3,000,000 per claim
Liability $3,000,000 anni 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.
re
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 R0_ 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
V--%;P 0)L REPRESENTATIVE
ACORD 25 (2001/08) 1 of 2 #S174426/M168598 KJS 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.
2t
aF -COd
ACORD 25-S (2001/08) 2 of 2 #S1 74426/Ml 68598
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
MUTUAL INSURANCE INC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P O BOX 12350 COMPANIES AFFORDING COVERAGE
ST PETE FL 33733-2350 COMPANY
A AUTO OWNERS INS CO
INSURED COMPANY
HARVARD, JOLLY, INC. B
COMPANY
2714 DR MLK JR ST N C
ST PETERSBURG FL 33704-2722 COMPANY
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ERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
T
THIS IS
O C
TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
TWITHSTANDING ANY REQUIREMENT
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N
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INDICAT
O
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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE
DATE (MMIDDNY) POLICY EXPIRATION
DATE (MMIDONY) LIMITS
LTR
GEN ERAL LIABILITY BODILY INJURY OCC $
COMPREHENSIVE FORM BODILY INJURY AGO $
PREMISES/OPERATIONS PROPERTY DAMAGE OCC $
XPL
N PROPERTY DAMAGE AGG $
COLLAPSE HAZARD
OSION &
E
PRODUCTS/COMPLETED OPER BI & PD COMBINED OCC S.
CONTRACTUAL BI & PD COMBINED AGG $
INDEPENDENT CONTRACTORS PERSONAL INJURY AGG $
BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY
A AUTOMOBILE LIABILITY 9677117000 11 08/08 11/08/09 BODILY INJURY
X (Per person) § 1,000,000
ANY AUTO
ALL OWNED AUTOS (Private Pass) BODILY INJURY
(Per accident)
000
$ 1
000
AUTOS
ALLLL OWNED ,
,
P
(Otharthan rivate asaenoer)
X
X HIRED AUTOS ?. PROPERTY DAMAGE $
500,000
NON-OWNED AUTOS
O? BODILY INJURY &
GARAGE LIABILITY 1 1 PROPERTY DAMAGE $
J COMBINED
C
? EACH OCCURRENCE $
EXC ESS LIABILITY QR
?
AGGREGATE
$
UMBRELLA FORM $
OTHER THAN UMBRELLA FORM
MI S
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY EL EACH ACCIDENT $
THE PROPRIETOR/ EL DISEASE-POLICY LIMIT $
PARTNERS/EXECUTIVE INCL
EL DISEASE-EA EMPLOYEE
$
OFFICERS ARE: EXCL
OTHER
DESCRIPTION OF OPERATION&LOCATIONSIVEHICLESISPECIAL ITEMS
THE CITY OF CLEARWATER IS AN ADDITIONAL INSURED AS PER THE COMMERCIAL AUTO
LIABILITY.
PROJECT: CITY OF CLEARWATER
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
CITY OF CLEARWATER I_Q_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
ENGINEERING DEPARTMENT BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
100 S MYRTLE AVE OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
CLEARWATER FL 3 3 7 5 6 AUTHORIZED Arn
Ext. 2214 A
Mitchell sh,
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DATE (MM/DD/YY)
0/29/08
PRODUCER
MUTUAL INSURANCE INC
P O BOX 12350
ST PETE FL 33733-235
NSURED
HARVARD, JOLLY, INC.
2714 DR MLK JR ST N
ST PETERSBURG FL 33704-272
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.
COMPANIES AFFORDING COVERAGE
COMPANY
A AUTO OWNERS INS CO
COMPANY
B
COMPANY
C
COMPANY
D
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
T TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
_CO DATE (MM/DD/YY) DATE (MMMMY)
GENERAL LIABILITY BODILY INJURY OCC $
COMPREHENSIVE FORM
PREMISES/OPERATIONS
UNDERGROUND
EXPLOSION & COLLAPSE HAZARD
PRODUCTS/COMPLETED OPER
CONTRACTUAL
INDEPENDENT CONTRACTORS
BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY
A AUTOMOBILE LIABILITY
X ANY AUTO
ALL OWNED AUTOS (Private Pass)
9677117000
BODILY INJURY AGG
1 PROPERTY DAMAGE OCC
YO V 0,1 2008 PROPERTY DAMAGE AGG
BI & PD COMBINED OCC
FF -; j l RECO RD'S AI` BI & PD COMBINED AGG
I•? .i! '.,??' ( DEN PERSONAL INJURY AGG
- 1
1/08/08
1 1
1T08/09 BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
$ 1,000,00
$ 1,000,00
X HIRED AUTOS PROPERTY DAMAGE $
X
OWNED AUTOS
NON
R 500,000
-
GARAGE LIABILITY ECEI VED
BODILY INJURY &
PROPERTY DAMAGE
$
COMBINED
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM OCT 2OOH AGGREGATE $
OTHER THAN UMBRELLA FORM $
WORKERS COMPENSATION AND CM OF CL MATER T LIMI S R
EMPLOYERS' LIABILITY ENGINEERING D RFT'MW EL EACH ACCIDENT $_?
THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT $
PARTNERS/EXECUTIVE
OFFICERS ARE:
EXCL
EL DISEASE-EA EMPLOYEE
$
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
THE CITY OF CLEARWATER IS AN ADDITIONAL INSURED AS PER THE COMMERCIAL AUTO
LIABILITY.
PROJECT: CITY OF CLEARWATER
CITY OF CLEARWATER
ENGINEERING DEPARTMENT
100 S MYRTLE AVE
CLEARWATER FL 33756
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO IL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY D PON E COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REP SENT E
Mitche a . 2214 MS A
Client#: 2476
HARVJOL3
ACORD, CERTIFICATE OF LIABILITY INSURANCE
DATE
10
/29/2008 '
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 Indemnity Company 25658
2714 Or Martin Luther King Jr St N INSURER c: Travelers Casualty and Surety Co 19038
St Petersburg, FL 33704 INSURER D: XL Specialty Insurance Company 37885
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.
INUIR LTR NSR
TYPE OF INSURANCE
POLICY NUMBER
Y RATION
LIMITS
A GENERAL LIABILITY 6606514L487 11081 1.1/08`/08 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY DAM
AGE TO RENTED
E MISES (E. )81
$300 000
CLAIMS MADE 7 OCCUR >! A
t"40 V o 4 2
008
MED EXP (Any one person)
s5,000
PERSONAL & ADV INJURY $1,000,000
®F II `Af
RECOR DS ANG GENERAL AGGREGATE s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: LG -
L
A
V G
S C' Py?
PRODUCTS - COMP/OP AGG
s2,000,000
O- T LOC
POLICY X EC
-]
r H
Y
it
LJC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
$
ANY AUTO (Ea accident)
ALL OWNED AUTOS ?oOp
BODILY INJURY
T
OC 0 (Per person) $
SCHEDULED AUTOS I
HIRED AUTOS
BODILY INJURY
NON-OWNED AUTOS
CITY OF C
EARWNATER
(Per accident) $
ENGINEERING DEPARTMENT PROPERTY DAMAGE
(Per accident) $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
B EXCESSIUMBRELLA LIABILITY CUP7798Y577 11/08/07 11108/08 EACH OCCURRENCE $4,000,000
X OCCUR 0 CLAIMS MADE AGGREGATE $4,000,000
DEDUCTIBLE $
X RETENTION $ 10000 $
C WORKERS COMPENSATION AND UB5238Y87 01/01/08 01/01/09 X I TORY WC LIMIT ER
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$110001000
OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1,000,000
describe under
Use
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$1,000,000
D OTHER Professional DPR9613427 06130108 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.
GEKTIFIGATE KOLDEK
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 A() 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
AUPI)RLTED REPRESENTATIVE
-ACORD 25 (2001/08) 1 of 2 #S174426iM168598 KJS ® ACORD CORPORATION 1988