CERTIFICATE OF LIABILITY INSURANCE (10)
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ACDBDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MMJDD/VV)
06/24/05
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Suncoast Insurance Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTlRCATe
P.O. Box 22668 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tampa, FL 33622-2668
813289-5200 INSURERS AFFORDING COVERAGE
INSURED INSURER A: United States Fidelity & Guaranty
TBE Group, Inc. INSURER B: XL Specialty Insurance Company
380 Park Place Blvd. Suite 300 INSURER c: St Paul Fire & Marine
Clearwater, FL 33759 ---.------
INSURER D:
I INSURER E:
Client#: 3103
TAMPBAY3
COVERAGES
THE POLICIES OF INSURANCE LISTED SELOW 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. AGGREGA"TE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSR TVPE OF INSURANCE POLICY NUMBER POLICY I!I'FECTlVE '1~iJ=~~N LIMITS
LTR DAle
A GENERAL LIABILITY BK01413156 06/30/05 06130/06 EACH OGOJRRENCE $1.000 000 ..
f--
~ COM M ERCIAL GENERAL LIAS I UlY FIRE DAMAGE fA", one fire) $1.000 000
- ~ ClAIMS MADE 00 OCOJR MED EXP f/'ny one person) $10000
PERSONAL Bo ADV INJURY $1.000 000
GENERAl AGGREGATE $2.000 000
~'LAGGREGATELlM IT AnSPER: PRODUCTS - COMPIOP AGG $2.000 000
nPRO-
POUCY JECT LOG
C AUTOMOBILE LIABILITY CA06614422 06/30/05 06130/06 COMBINED SINGLE UMIT
- (Ea accidert) $1,000,000
..!.. ANY AUTO
ALL OWNED AUTOS BOOIL Y INJURY
f-- $
SCHEDULED AUTOS (per person)
-
~ HIRED AUTOS BOOILYINJURY
$
X NON-OWNED AUTOS (per accidenl)
-
PROPERlY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY -EAACCIDENT $
~ ANY AUTO OTHER THA"J EAACC $
AUTO ONLY: AGG $
A EXCESS LIABlUTY BK01413156 06/30/05 06/30/06 EACH OCCURRENCE $9.000.000
txJ OCCUR D CLAIMS MADE AGGREGATE $9.000.000
$
R DEDUCTIBLE $
RETENTION $ $
C WVA7720349 06/30/05 06130/06 X ~~CSTATU- I IOTH-
WORKERS COMPENSATION AND my LIMITS ER
EMPLOYERS' LIABILITY E,L EAQj ACQDENT $1,000,000
EL DISEAl?E - EA EMPLOYEE $1,000,000
EL, DISEASE -POlICYlIMIT $1.000,000
B OTHER DPR9408068 11/26/04 11/26/05 $5,000,000 Eaeh Claim
Professional $5,000,000 Ann Aggr
ia bility
DESCRIPTION OF OPERATlONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPEClAL PROVISIONS
Professional Liability Is written on a claims made and reported basis.
CERTIFICATE HOLDER I I ADDITIONALINSURED;INSURERLETTER: CANCELLATION
SHOULD PHYOFTH E ABOVE DESCRIBED PO..ICIES BE CANCELLED BEFORE TH E ElCPlRATlON
City of Clearwater DATE lliEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAlL~DA'lSWRITTEN
Engineering Dept. - Ste. 220 NOllCETOlliE CERTIFICATE HOLDER NAMED TOTHELEFT, BUT FAILURE TODD SO SHALL
PO Box 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON TH E INSURER,ITS AGENTS OR
Clearwater, FL 33758-4748 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
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ACORD 25-5 (7!97)1 of 2
#51 06748/M1 06730
KJS
~ ACORD CORPORATION 1988