CERTIFICATE OF INSURANCE (10)
Client#: 6108
GRIMCRA3
ACORD,.
CERTIFICATE OF LIABILITY INSURANCE
PRODUCER
Suncoast Insurance Associates
P.O. Box 22668
Tampa, FL 33622-2668
813289-5200
DATE (MM/DDIYY)
12/16/03
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.
INSURERS AFFORDING COVERAGE
INSURED
INSURER A:
INSURER B:
INSURER C:
United States Fidelity & Guaranty
American Manufacturers Mutual
Security Ins Co of Hartford
Grimail Crawford, Inc.
5444 Bay Center Dr., Suite 204
Tampa, FL 33609
INSURER D:
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.
i~f:~~-""~-;E O~ INSURANCE POLICY NUMBER Pgk!fe",~~~~~~ P~~fJ 1~';)~;WIN
AUTO ONLY - EA ACCIDENT $
EA ACC $
AGG $
.1.$
i
$
$
$
$
X IT~~~T~JI~~ I IOTH'i
_~,LER.+.~__~__.._. .....
g" EA(~H A(;CIDENT_____~J.1 00,0.00 ._.___. n'_
~-~II:::;~;;~~~~;~;j~~~~~~~ci --- .....-
$1,000,000 Each Claim
$1,000,000 Aggregate
!In~ R (0)1" rr; n, \117
II ,.. l!:; Iq I[ U I
ill r-""-- ~L -"'.-.".
I '\ i
Ilru l DEe I 7 20m
---"---;',--;C;-.- _
CANCELLATION DIID. .~T"!I.:.iS~(' .C.I.' '''\;ATIG
SHOULD ANY OF TH E ABOVE DESCRIBED POLICIES BECANCELLED BEFORE TH E EXPIRATION"
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30........ DAYS WRllTEN
NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUT FAILURE TODOSOSHALL
IMPOSE NO OBLIGATION OR LIABiLITY OF ANYKlND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
~~~RIZED REPRESENTATIVE
/'"i ... . ~ ~ t::.. . '0-"1. *. )
A ~NERAL LIABILITY
X ~~ M ERCIAL GENERAL L1AB ILlTY
_ --.J CLAIMS MADE W OCCUR
BK01231322
10/14/03
10/14/04
EACH OCCURRENCE
FIRE DAMAGE (Anyone fire)
MED EXP (Anyone person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS . COMP/OP AGG
-
-
GEN I'LAGGRErGAT~L1MITAPPLlEfPER:
POLICY I i j:C?,: i LOC
A AUTOMOBILE LIABILITY
BK01231322
10/14/03
10/14/04
COMBINED SINGLE LIMIT
(Ea accident)
-
-
-
X
X
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
BODILY INJURY
(Per accident)
1---. -.-.----.- -------
PROPERTY DAMAGE
(Per accident)
BODILY INJURY
(Per person)
nRAGE LIABILITY
11 ANY AUTO
OTHER THAN
AUTO ONLY:
EXCESS LIABILITY
'J OCCUR l..,.-l CLAIMS MADE
EACH OCCURRENCE
AGGREGATE
RDEDUCTIBLE
RETENTION
B
7CQ61314603
WORKERS COMPENSATION AN'D
EMPLOYERS' LIABILITY
OS/22/03
OS/22/04
C
OTHER
Professional
Liabilitv
AEE0230309
OS/29/03
OS/29/04
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIALPROVISIONS
Professional Liability is written and reported on a claims made basis.
CERTIFICATE HOLDER
: ...... . .', ,.::e:
I I ADDITIONALINSURED'INSURERLElTER:
City of Clearwater
Engineering Department
Suite 220
PO Box 4748
Clearwater, FL 33758-4748
I
ACORD 25-S (7/97)1 of 2
#S82444/M80090
LIMITS
$1 000 000
$300 000
$10.000
$1 000000
$2 000 000
n!.2.LQ.Il.Q.9J!1!
1$1,000,000
I
1$
!
T$
..
. ......
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LMH
@ ACORD CORPORATION 1988