CERTIFICATE OF LIABILITY INSURANCE (4)A-CORD..
DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 1 11125/08
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Suncoast Insurance Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Box 22668
P
O HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
.
. ALTER THE COVERAGE AFFORDED BY THE POLIC IES BELOW.
Tampa, FL 33622-2668
81 289-5200 INSURERS AFFORDING COVERAGE I NAIC #
INSPIRED INSURER A: Travelers Property Casualty 36161
TBE Group, Inc.
INSURERS: St. Paul Fire & Marine Insurance Co - - - -"
24767
380 Park. Place Blvd. Suite 300 INSURER C: Phoenix Insurance Company 25623
Clearwater, FL 33759
INSURER D: XL Specialty Insurance Company
37885
INSURER E: St. Paul Mercury Insurance Company- 24791
RAGES
1 T E POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
A Y 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
PIOLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INS
LTR' ADD'
NSR
TYPE OF INSURANCE
POLICY NUMBER POLICY EFFECTIVE
DATE (MM/DD/YY) POLICY EXPIRATION
DATE (MMIDD_ /Y_YL
LIMITS
A GENERAL LIABILITY 22481_72A 06130/08 06/30/09 EACH OCCURRENCE $1,000,000- _
X MERCIAL GENERAL LIABILITY
COM DAMAGE TO RENTED
ES (Ea occurrence) __ 1
PREMIS
$I 000,000
D CLAIMS MADE a OCCUR MED EXP (Any one person) $5,400 = - - -
PERSONAL & ADV INJURY 1 $1,000,000
GENERAL AGGREGATE $21000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMPIOP AGG 1 $2,000,000
PRO-
POLICY JE
C LOC
-
E AUTOMOBILE LIABILITY CA06614432 06/30/08 06130/09 COMBINED SINGLE LIMIT
id [
$1 OOO
000
X ANY AUTO
ent
(Ea acc
9
,
T
ALL OWNED AUTOS BODILY INJURY
I
$
SCHEDULED AUTOS (Per person) I
X HIRED AUTOS BODILY INJURY
X NON-OWNED AUTOS (Per accident) $
[PROPERTY DAMAGE
accident) $
i GARAGE LIABILITY AUTO ONLY - EA ACCIDENT I $
ANY AUTO THER THAN EA ACC $
ONLY: AGG
[AUTO $
B EXCESS/UMBRELLA LIABILITY QK06501924 06/30108 06130/09 EACH OCCURRENCE 1 $9,000,000
_-
X OCCUR 7 CLAIMS MADE AGGREGATE 1 $9,000,000
I $
DEDUCTIBLE
I X
-- RETENTION $ 10000 $
C WORKERS COMPENSATION AND U66399Y464 06/30/08 06130109 WC STATU- L MIT
EMPLOYERS' LIABILITY [EL.
EACH ACCIDENT $000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED? I E.L. DISEASE - EA EMPLOYE
EI $1,000,000
If yes, describe under _
l -
1
000
000
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT ,
,
$
D OTHER Professional DPR9617724 11/26/08 11/26/09 $5,000,000 per claim
Liability $5,000,000 annl aggr.
nr :n
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS I V Im ¦=-
Professional Liability is written on a claims made and reported basis.
D EC '..
OF CLEARWATER
City of Clearwater
Engineering Dept. - Ste. 220
PO Box 4748
Clearwater, FL 33758-4748
CANCELLATION ENGINEERING DEPARTMENT
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -1 ( 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
25 (2001/08) 1 of 2 #M175789
AUTHORIZED REPRESEjdTATIVE
w/WQ-'?ri It 06-wb
MRL 0 ACORD CORPORATION 198.
V
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.
ORD 25S (2001/08) 2 of 2 #M175789