CERTIFICATE OF LIABILITY INSURANCE
ACORD.. CERTIFICA TE OF LIABILITY INSURANC~~~~~ J9 DATE (MM/DDIYY)
10/02/01
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Professional Underwriters, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 3139 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Farmington Hills, MI 48333
Phone: 248-855-3322 INSURERS AFFORDING COVERAGE
INSURED INSURER A: American Manufacturers Mutual
INSURER B: Lumbermens Mutual. Casualtv Co.
Wade-Trim, Inc. INSURER C American Protection Mutual
4919 Memorial Hwy., Suite 200 INSURER D: CNA Insurance Company
Tampa, FL 33634
I 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.
INSR lYPE OF INSURANCE POLICY NUMBER ~~'r~MLb~w{'YE Prl'1+~~~~r6~J}?N LIMITS
LTR
GENERAL LIABILllY EACH OCCURRENCE $ 1,000,000
-
A X COMMERCIAL GENERAL L1ABILllY 3MH 788146-01 10/01/01 10/01/02 FIRE DAMAGE (Anyone fire) $ 1,000,000
I CLAIMS MADE ~ 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 .nPRO- n
POLICY JECT LOC
AUTOMOBILE LIABILllY COMBINED SINGLE LIMIT $ 1,000,000
f--
B X ANY AUTO F3D 038281-01 10/01/01 10/01/02 (Ea accident)
f---
ALL OWNED AUTOS BODILY INJURY
f--- $
SCHEDULED AUTOS (Per person)
f--
HIRED AUTOS BODILY INJURY
f--- (Per accident) $
NON-OWNED AUTOS
f--
f--- PROPERlY DAMAGE $
(Per accident)
RGE LIABILllY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EAACC $
AUTO ONLY: AGG $
EACH OCCURRENCE $ 14,000,000 -
EXCESS LIABILllY
B ~ OCCUR D CLAIMS MADE 3SX 124575-01 10/01/01 10/01/02 AGGREGATE $ 14,000,000
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X I TORY L1MrrS I IOJ~-
C EMPLOYERS' LIABILllY 3BR 014778-01 10/01/01 10/01/02 $ 500,000
E.L EACH ACCIDENT
E.L DISEASE - EA EMPLOYEE $ 500,000
E.L DISEASE - POLICY LIMIT $500,000
OTHER
D ARCH/ENG PROF LIAB AEA 1333326027 10/01/01 10/01/02 EA. CLAIM 10,000,000
CLAIMS MADE BASIS :...... - _.. - ~~.. 000.000
OED. AS STATED ON POLICY .,
DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS : 10 l, I~) l~ U \'J I~ ~
PROJECT NAME: 5-YEAR ENGINEER OF RECORD CONTRACT. I;
:~
; I I o.
, OCT
-
CITY OF CLEARWATER
CERTIFICA TE HOLDER I y I ADDITIONAL INSURED; INSURER LETTER: A CANCELLATION
CLEARWA SHOULD ANY OF THE ABOVE DESCRIBED POLICI.ES BE CANCELLED BEFORE THE EXPIRATION
CITY OF CLEARWATER, ..no '"'''0'. "" ""',. "."""...~ .."'w""",
PUBLIC WORKS ADMINISTRATION NOTICE TO THE CERTIFICA TO: , T FAILURE TO DO SO SHALL
ATTN: ALICE IMPOSENOOBLIGATIONOR~llY~ ...... I. R.~NTSOR
100 SOUTH MYRTLE AVENUE
CLEARWATER, FL 33758 REPRESENTATIVES. ~ ~;il:' . ,
AUTHORIZED REPRESENTATIVE ...
I Robert L. Coleman
ACORD 25-S (7/97)
@ACORDCORPORATION 1988