CERTIFICATE OF INSURANCE (18)
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYY)
0.6/26/0.4
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Suncoast Insurance Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 22668 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tampa, FL 33622-2668
813289-520.0. INSURERS AFFORDING COVERAGE
-.. -I INSURER A: United States Fidelity & Guaranty --
INSURED
TBE Group, Inc. INSURER B: Greenwich Insurance Compa.I1~.~
380. Park Place Blvd. Suite 30.0. f-..
INSURER c: St. Paul Fire & Marine
Clearwater, FL 33759 INSURER 0:
I INSURER E:
Client#: 310.3
T AMPBA Y3
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.
INSR TYPE OF INSURANCE POLICY NUMBER Pgk!fJ,~~gtJ.X~ P%~;l,~X';l~~N LIMITS
LTR
A GENERAL LIABILITY BKQ1413156 0.6/30./04 0.6/30./0.5 EACH OCCURRENCE $1 0.0.0. 000
I--
~ COMMERCIAL GENERAL L1AB ILlTY FIRE DAMAGE (Anyone fire) $1 000000
I-- =:J CLAIMS MADE W OCCUR i MED EXP (Anyone person) $10..000
PERSONAL & ADV INJURY $1 000. 000
1-
GENERAL AGGREGATE $2 00.0. 000.
I--
GEN'L AGGREGATE L1M IT APPLIES PER: PRODUCTS . COMP/OP AGG $2 000. 000
Ii POLICY n j~gT il LOC
C AUTOMOBILE LIABILITY CAQ6614422 06/30/0.4 0.6/30./05 COMBINED SINGLE LIMIT
- $1,0.0.0.,00.0
~ ANY AUTO (Ea accident)
- ALL OWNED AUTOS BODILY INJURY
(Per person) $
- SCHEDULED AUTOS
~ HIRED AUTOS BODILY INJURY
$
~ NON.OWNED AUTOS (Per accident)
- I PROPERTY DAMAGE
i (Per accident) $
~RAGE LIABILITY I AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
i AUTO ONLY: AGG $
A EXCESS LIABILITY BK01413156 I 06/30/04 06/30./0.5 EACH OCCURRENCE $9.000. 00.0.
~ OCCUR D CLAIMS MADE I AGGREGATE $9.00.0 00.0
I $
=1 DEDUCTIBLE I $
RETENTION $ $
C WORKERS COMPENSATION AND WV A 7720349 0.6/30./04 06/30./05 X 1fr,~~T~J,~:" I IOJ~-
EMPLOYERS' LIABILITY $1,000.,0.00
I E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPL OYEE $1,000,0.0.0.
E.L. DISEASE - POLICY LIMIT $1,0.0.0,0.00.
B OTHER PEC0015437 11/26/03 11/26/04 $5,00.0,0.00 Each Claim
Professional $5,0.00,000 Ann Aggr
Liabilitv
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Professional Liability is written on a claims made and reported basis.
CERTIFICATE HOLDER I I ADDITIONAL INSURED' INSURER LETTER: CANCELLATION
SHOULD ANYOFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL3G._DAYSWRITTEN
%Public Works Administration NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUTFAJLURE TOOOSOSHALL
100 South Myrtle Avenue IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
Clearwater, FL 33756 REPRESENTATIVES.
AUTHORIZEO REPRESENTATIVE
I AC-;, h\.. f'J()~ ,a--
ACORD 25-S (7/97)1
of2
#M90156
MOL
@ ACORD CORPORA nON 1988
i
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 25-5 (7/97)2 of 2 #M9 0 15 6