CERTIFICATE OF LIABILITY INSURANCE (78)wienz*: vcya DATE (MMIDDIYYYY)
ACORM CERTIFICATE OF LIABILITY INSURANCE 02118109
THIS CERTIFICATE IS ISSUED AS A MATTER 67 1
PRODUCER NFORMATION
S PRODUCER
t Insurance Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. BDX 22668 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tampa, FL 33622-2668
813 289-5200
INSURED
Advanced Engineering & Design, Inc.
3931 68th Avenue North
Pinellas Park, FL 33781
INSURERS AFFORDING COVERAGE NAIC #
INSURER A:-Old Dominion Insurance Company 40231
INSURER B: Travelers Casualty and Surety Co 19038
INSURER C: XL Specialty Insurance company 37885
INSURER D:
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
LIC . EFFE E EXPIRATIO
ATE MIIR LIMITS
LTR NSR TYPE OF INSURANCE POLICY NUMBER D TE
02116109 02/16/10 EACH OCCURRENCE $1 000 000
A GENERAL LIABILITY BPG2647A DAMAGE TO RENTEDn $500,000
X COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $5000
CLAIMS MADE OCCUR _?.
PERSONAL & ADV INJURY $1 000 000
GENERAL AGGREGATE $2 000 000
d FIC L'.. REC.UI Ds Wr?ILI PRODUCTS -COMP/OP AGG $2 000 000
GEN'L AGGREGATE LIMIT APPLIES PER: LE ISLATIVE SRV S DEVI
POLICY JECT LOC
BPG2647A
02/16109 02/16/10
COMBINED SINGLE LIMIT $1,000,000
A AUTOMOBILE LIABILITY (Fa accident)
ANY AUTO
BODILY INJURY $
ALL OWNED AUTOS (Per Perim)
SCHEDULED AUTOS
X HIRED AUTO SID BODILY INJURY $
(Per ecrJdent)
X NON-OWNED AUTOS
PROPERTY DAMAGE $
(Per accident)
AUTO ONLY - EA ACCIDENT $
GARAGE LIABILITY r ,)
r c?
F EA ACC $
OTHERTHAN
ANY AUTO 1`
-- AUTO ONLY: AGG $
LIABILITY I?PIPW EACH OCCURRENCE $
EXCESg/UMBREL.LA
OCCUR CLAIMS MADE of PPR
??? 0? AGGREGATE $
$
DEDUCTIBLE $
RETENTION $
UB708OY490
09/O1I08 09/01/09 WC STATU• OTH-
X
WORKERS COMPENSATION AND L. EACH ACCIDENT $1 OD,D00
E
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE .
E.L. DISEASE. EA EMPLOYEE $100,000
OFFICERIMEMBER EXCLUDED?
DISEASE - POLICY LIMIT $5DDr00D
E
L
If yes, describe under
SPECIAL PROVISIONS below
DPF9618302
02115109 02115/10 .
.
$2,000,000 per claim
c OTHER Professional $2,000,000 annl aggr.
Liability
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Professional Liability is written on a claims made and reported basis.
CANCELLATION
city of Clearwater
Attn: Kathy Bedini
P.O. Box 4748
Clearwater, FL 33758.4748
ACORD 25 (2001/08) 1 of 2 #M180662
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
A ORLMO REPRESENTATIVE
I 1-ft 0--W- AO-- --
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