CERTIFICATE OF INSURANCE (8)
Date: 07/09/03 Time: 02:16 PM To: 7274626989
813-289-4561
Page: 002-003
Clientl#: 3103
TAMPBAY3
ACDBD. CERTIFICATE OF LIABILITY INSURANCE
DATE (MM,.oDlYV)
06/29/03
THIS CERTlFlCATE IS ISSUED AS A MAlTER OF INFORMATION
ONLY AND CONFERS NO RIGKTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
PRODUCER
Suncoast Insurance Associates
P.O. Box 22668
Tampa, FL 33622-2668
813289-5200
INSURERS AFFORDING COVERAGE
TBE Group, Inc.
380 Park Place Blvd Suite 300
Clearwater, FL 33759
INSURER A: United States Fidelity & Guaranty
INSURER B: St Paul Fire & Marine Ins CO
INSURER C: Security Ins Co of Hartford
INSURED
INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE L1SlED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICAlED, NOlWlTHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICAlE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE lERMS, EXCLUSIONS AND CONDmONS OF SUCH
POLICIES, AGGREGAlE L1M ITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE ~~.w),!;l~~N LIMITS
LTR DATE
A GENERAL LIABILITY BK01413156 06/30/03 06/30/04 EACH OCCURRENCE $1 000,000
-
X COM M ERCIAL GENERAL L1AB ILlTY FI RE DAMAGE (f\ny one lire) $1 000.000
- ~ CLAIMS MADE [!J OCCUR MED EXP (Anyone person) $10.000
PERSONAL & ACIIIINJURY $1 .000.000
GENERAL AGGREGATE $2.000.000
GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS -COM~OPAGG $2,000,000
I ,nPRO- n
POLICY JECT LaC
A AUTOMOBILE LIABILITY BA01413079 06/30/03 06/30/04 COMBINED SINGE LIMIT
- $1 ,000,000
~ ANY AUTO (Ee acddent)
ALL OWNED AUTOS BroiL Y INJURY
- $
SCHEDULED AUTOS (Per person)
-
~ HI RED AUTOS BrolLYINJURY
$
X NON-OWNED AUTOS (Per accident)
-
PROPERTY DAMAGE $
(per accid""l)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA />CC $
AUTO ONLY: AGG $
A EXCESS LIABILITY BK01413156 06/30/03 06/30/04 EAa-I OCCURRENCE $7 000.000
::!J-OCOJR D CLA!MSMADE AGGREGATE $7.000,000
$
~ CEOUCTIBLE $
RETENTION $ $
B WORKERS COMPENSATION AND WVAn20349 06130/03 06/30/04 l,.~<2..~T~1,~;, I X pr~-
EMPLOYERS' LIABILITY $1 .000.000
EL EACH />CO CENT
EL DISEASE -EAEMPLOYEE $1 .000.000
EL DISEASE - POLICY LIMIT $1 .000.000 '
C OTHER AEE0703183 06/30/03 06/30/04 $5,000,000 Each Claim
Professional $5,000,000 Ann Aggr
labllltv
DESCRIPTION OF OPERATIONS,l..OCATlONSNEHICLES,EXQ.USlONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Professional Liability is written on a claims made and reported basis.
CERTIFICATE HOLDER I I ADOmONAL INSURED'INSURER LETTER: CANCELLATION
SH OULD ANY<FTH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TH E EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER W1U ENDEAVOR TO MAIL 3ll.-.DA'/S WRITTEN
%Public Works Administration NOTICETOTHE CERTIFICATE HOLDER NAM EO TOTHE LEFT, BUT FAILURE TODOSOSHALL
100 South Myrtle Avenue 1M POSE NO OBLIGATION OR LIABILlTYOF ANYKlND UPON TH E INSURER,ITS AGENTS OR
Clearwater, FL 33756 REPRESENTATIVES,
4U.!f.1RIZED REPRESENTATIVE ....'1 ~, - )
I 1. iA.u...II!~L.' ~
ACORD25-S(7/97)1 of2
I#S76153/M75705
MOL
ISI ACORD CORPORATION 1888
Date: 07/09/03 Time: 02:16 PM To: 7274626989
813-289-4561
Page: 003-003
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,
ACORD25-S(7;'97)2 of 2 #S76153/M75705