CERTIFICATE OF INSURANCE (2)
ACORDN
CERTIFICATE OF LIABILITY INSURANCE
Professional Underwriters,
P.O. Box 3139
Farmington Hills, MI 48333
Phone: 248-855-3322
INSURED
Inc
OP 10 J DATE (MMlDDIYYYY)
WADET-8 08 01 03
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
INSURERS AFFORDING COVERAGE
NAIC#
Wade-Trim, Inc.
4919 Memorial Hwy., Suite 200
Tampa, FL 33634
INSURER A:
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
American Motorists Insuranc
Lumbermens Mutual Casualty o.
Star Insurance Company
CNA Insurance Company
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.
IN::iK ~~'ki TYPE OF INSURANCE POLICY NUMBER ~~I;!~~rXWo"~,.:.!XE P8k~CEY(~~bRif~N LIMITS
LTR
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
"--
A X X COMMERCIAL GENERAL LIABILITY 3MG 788180 10/01/02 10/01/03 u~!!'~~~ $1,000,000
PREMISES(Ea occurence)
I CLAIMS MADE [!J OCCUR MED EXP (Anyone person) $10,000
PERSONAL & ADV INJURY $1,000,000
-
GENERAL AGGREGATE $2,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
I !Xl PRO- nLOC
POLICY X JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $1,000,000
B X ~ ANY AUTO F3D 038281 10/01/02 10/01/03 (Ea accident)
- ALL OWNED AUTOS BODILY INJURY
(Per person) $
SCHEDULED AUTOS
"--
HIRED AUTOS BODILY INJURY
I-- $
NON-OWNED AUTOS (Per accident)
"--
"-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 14, 000, 000
B t!:J OCCUR D CLAIMS MADE 3SX 124575 10/01/02 10/01/03 AGGREGATE $14,000,000
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X I T8'~WI~WS I 1\.J~'1-
ER
C EMPLOYERS' LIABILITY 0156634 10/01/02 10/01/03 E.L. EACH ACCIDENT $500,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 500,000
If yes, describe under E.L. DISEASE - POLICY LIMIT $500,000
SPECIAL PROVISIONS below
OTHER
D ARCH/ENG PROF LIAB AEA 1333326027 10/01/02 10/01/03 EA. CLAIM 10,000,000
CLAIMS MADE BASIS OED. AS STATED ON POLICY ,I-."....--A E 15,000,000
""'"""'" 0' o"",no,,, co,.,"'''' ''''''''''' """''''''''' AD'''' " '"00""""" """" '''''''''''' . : . 1 ! \ ir' r! n WI ~ ill
PROJECT, ENGINEER OF RECORD. THE CITY OF CLEARWATER IS NAMED AS AN ill!,-&~ . ~
ADDITIONAL INSURED WITH RESPECT TO THE GENERAL LIABILITY AND AUTO L~ILITY. ~
! I I;. 2
fUUI ..[ - 5 002
L___....___.__ ,
r ITV ()( I'.' :;,"-;::-
CERTIFICATE HOLDER CANCELLATION PIJBUC WORKS ADMiNiSfRHlfllI
CLEARW1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THEEXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
CITY OF CLEARWATER NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
ATTENTION: GLEN BARNICK IMPOSE NO OBLIGATION OR LIABILITY OF.ANY KI~ U~~~RER, ITS AGENTS OR
P.O. BOX 4748
CLEARWATER, FL 33758-4748 REPRESENTATIVES. ........ ""' ........
AUTHORIZED REPRESENTATIVE -, ~~...-
Robert L. Coleman
ACORD 25 (2001/08) ~ IS. o1{lYco~po'k~ffl>N 1988