CERTIFICATE OF INSURANCE
ACORD..
CERTIFICATE OF LIABILITY INSURANCI;AD~~~~ DA~E~~~~D7012
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.
Inc
PRODUCER
Professional Underwriters,
P.o. Box 3139
Farmington Hills, MI 48333
Phone: 248-855-3322
INSURERS AFFORDING COVERAGE
INSURED
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
American Motorists Insurance
Lumbermens Mutual Casualty Co.
Star Insurance Company
CNA Insurance Company
Wade-Trim, Inc.
4919 Memorial Hwy., Suite 200
Tampa, FL 33634
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.
I~T: TYPE OF INSURANCE POLICY NUMBER LIMITS
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND'
EMPLOYERS' LIABILITY
0156634
EACH OCCURRENCE $1,000,000
10/01/02 10/01/03 FIRE DAMAGE (Anyone fire) $1,000,000
MED EXP (Anyone person) $10,000
PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
PRODUCTS. COMP/OP AGG $2,000,000
COMBINED SINGLE LIMIT $1,000,000
10/01/02 10/01/03 (Ea accident)
BODILY INJURY $
(Per person)
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE $
(Per accident)
AUTO ONLY. EA ACCIDENT $
OTHER THAN EA ACC $
AUTO ONLY: AGG $
EACH OCCURRENCE $14,000,000
10/01/02 10/01/03 AGGREGATE $ 14,000,000
$
$
$
X .
TORY LIMITS
10/01/02 10/01/03 E.L. EACH ACCIDENT $ 500,000
E.L. DISEASE. EA EMPLOYEE $ 500, 000
E.L. DISEASE. POLICY LIMIT $ 500,000
GENERAL LIABILITY
A X COMMERCIAL GENERAL LIABILITY 3MG 788180
CLAIMS MADE [!] OCCUR
LOC
B X ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
F3D 038281
GARAGE LIABILITY
ANY AUTO
EXCESS LIABILITY
B X OCCUR D CLAIMS MADE 3SX 124575
C
OTHER
D ARCH/ENG PROF LIAB ABA 1333326027
CLAIMS MADE BAS I S DED. AS STATED ON POLler
DESCRIPTION OF, OPERATIONSlLOCATIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
PROJECT NAME: 5 - YEAR ENGINEER OF RECORD CONTRACT. THE CERTIFICATE HOLDER
NAMED AS AN ADDITIONAL INSURED WITH RESPECT TO THE GENERAL LIABILITY.
10/01/02
10/01/03
EA. CLAIM
AGGREGATE
10,000,000
15,000,000
IS
CERTIFICATE HOLDER
Y ADDITIONAL INSURED; INSURER LETTER: A
CANCELLATION
CITY OF CLEARWATER,
ATTN: ALICE ECKMAN
410 N. MYRTLE AVENUE
CLEARWATER, FL 33755
CLEARWA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ...J.L 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 I
REPRESENTATIVES. ~
ALiTHORIZED REPRESENTATIVE
Robert L. Coleman
ACORD 25-5 (7/97)