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CERTIFICATE OF LIABILITY INSURANCE (99)rlinnfil. 5Q49 AnVA.^SYR'i ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE DnvvY) 3/10/09 0 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Suncoast Insurance Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Box 2266$ P O HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR . . ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Tampa, FL 33622-2668 813 289-5200 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Phoenix Insurance Company 25623 Advanced Systems Engineering, Inc. INSURER B: Travelers Indemnity Company 25658 13555 Automobile Blvd. INSURER c: Travelers Casualty and Surety Co 19038 Suite 330 INSURER D: XL Specialty Insurance Company 37885 Clearwater, FL 33762 INSURER E: rnVFRAr%PR 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 LTR DD' NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD Y POLICY EXPIRATION D TE MM DD YY LIMITS A GENERAL LIABILITY 6606$51 L26A 16/02/08 10/02/09 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY D PREMISES (Ea occurrenc 1 AMAGE TO RENTED $1 M01000 CLAIMS MADE FX_1OCCUR MED EXP (Any one person) $10,000 PERSONAL 6 ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG L2,000,000 17 POLICY X PRO LOC JECT B AUT OMOBILE LIABILITY BA48831_691 0$/17/08 08/17/09 COMBINED SINGLE LIMIT ' (Ea accident) $1,000,000 ANY AUTO I ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS II (Per person) $ X HIRED AUTOS - Pl?? f 2 BODILY INJURY w w t P id $ X NON-OWNED AUTO$ ) er acc en ( - - -- -- I PROPERTY DAMAGE F 1 C .? - (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ B EXCESS/UMBRELLA LIABILITY CUP6849Y191 08/17/08 08/17/09 EACH OCCURRENCE s5,000,000 X OCCUR FICLAIMS MADE AGGREGATE s5,000,000 DEDUCTIBLE $ X RETENTION $ 10000 C -- - --- ---_ COMP - t=NSATION AND ORK-ER-$:- TJB6848Y20T0'$? 08/17!08 08/17/09 X FIR EMPLOYERS' LIABILITY O R ETOR/P RT ER/E EC TI E E.L. EACH ACCIDENT $500,006 ANY PR P I A N X U V OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $500,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $500,000 D OTHER Professional DPR9618465 03/10/09 03110/10 $1,000,000 per claim Liability $1,000,000 annl aggr. DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Professional Liability is claims made and reported. Certificate holder is listed as an additional insured with respects to General Liability, Auto Liability and Excess Liability policies on a primary and non-contributory basis. Waiver of Subrogation in favor of the (See Attached Descriptions) L:CK I IFIL:A I M MULUtK I.ANI.t LLA I IUIN City of Clearwater Attn: City Clerk PO Box 4748 Clearwater, FL 33758-4748 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 'If) 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 REPRESENTATIVES. VAUTHORIZED REPRESENTATIVE Aal ACORD 25 (2001/08) 1 of 3 #M181847 KEB © ACORD CORPORATION 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-S (2001/08) 2 of 3 #M181847 DESCRIPTIONS (Continued from Page 1) additional insured applies to the General Liability, Auto Liability, Excess Liability and Workers Compensation policies. AMS 25.3 (2009108) 3 of 3 #M181847