CERTIFICATE OF INSURANCE (21)
.... .
professional Underwriters,
P.o. Box 3139
Farmington Hills, MI 48333
Phone: 248-855-3322
INSURED
Inc
OP 10 DATE (MMlDDNYYY)
WADET-8 10 25 04
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEN!;), EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
ACORD.
CERTIFICATE OF LIABILITY INSURANCE
PRODUCER
INSURERS AFFORDING COVERAGE
NAlC#
Wade-Trim, Inc.
4919 Memorial Hwy., Suite 200
Tampa, FL 33634
INSURER A:
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
St. Paul Mercury Insurance o.
Continental Casualty Compan 20443
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 OOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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.
LTR NSR[ TYPE OF INSURANCE POUCY NUMBER DATE iMMlDomi P8k!fEYI~rXb~J!,~N LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
-
A X X COMMERCIAL GENERAL LIABILITY CK02102969 10/01/04 10/01/05 UAMAlit: I U "",. I "u $1,000,000
PREMISES (Ea occurence)
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $10,000
PERSONAL & ADV INJURY $1,000,000
I-
GENERAL AGGREGATE $2,000,000
I--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG $2,000,000
h .[ilPRO- n
POLICY X JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
I-- $1,000,000
A X ANY AUTO CK02102969 10/01/04 10/01/05 (Ea accident)
I--
ALL OWNED AUTOS BODILY INJURY
C--- $
SCHEDULED AUTOS (Per person)
I--
HIRED AUTOS BODILY INJURY
- $
NON.OWNED AUTOS (Per accident)
I--
Ic-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
==l ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCEss/UMBRELLA LIABILITY EACH OCCURRENCE $14,000,000
A !J OCCUR o CLAIMS MADE CK02102969 10/01/04 10/01/05 AGGREGATE $14,000,000
$
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X I TORY L1Mtn3 I IU~;t
A EMPLOYERS' LIABILITY WVA2103056 10/01/04 10/01/05
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500,000
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $500,000
If yes, describe under $ 500,000
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT
OTHER
B ARCH/ENG PROF LIAB AEA 1333326027 10/01/04 10/01/05 EA. CLAIM 5,000,000
CLAIMS MADE BASIS Dm!. AS STATKD 011 POLICY AGGREGATE 10,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
PROJECT NAME: 5-YEAR ENGINEER OF RECORD CONTRACT.THE CERTIFICATE HOLDER IS
NAMED AS AN ADDITIONAL INSURED WITH RESPECT TO THE GENERAL LIABILITY.
CITY OF CLEARWATER,
ATTN: ALICE ECKMAN
100 S. MYRTLE AVENUE
CLEARWATER, FL 33758
CANCELLATION
CLEARWA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAlL 30 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.
@ ACORD CORPORATION 1988
CERTIFICATE HOLDER
ACORD 25 (2001/08)