CERTIFICATE OF INSURANCE (22)
Client#: 6108
GRIMCRA3
TM
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDNY)
10/04/04
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
Suncoast Insurance Associates
P.O. Box 22668
Tampa, FL 33622-2668
813289.5200
Grimail Crawford, Inc.
5444 Bay Center Dr., Suite 204
Tampa, FL 33609
INSURERS AFFORDING COVERAGE
INSURER A: United States Fidelity & Guaranty
INSURER B: St. Paul Fire & Marine
INSURER C: Liberty Insurance Underwriters
INSURER 0:
INSURER E:
INSURED
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 TYPE OF INSURANCE POLICY NUMBER Pgk!fl/~J,gg~ POLICY EXPI~~N LIMITS
TR
A ~NERAL LIABILITY BK01231322 10/14/04 10/14/05 EACH OCCURRENCE $1 000 000
JL COMM ERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $300 000
I-- =:J ClAIMS MADE W OCCUR MED EXP (Anyone person) $10.000
PERSONAL & ADV INJURY $1 000 000
f--
GENERAL AGGREGATE $2 000.000
I--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $2,000,000
h POLICY n ~~2;: n LOC
~OMOBILE LIABIUTY - - , COMBINED SINGLE LIMIT
U ~ ~ W" (Ea accident) $
f-- ANY AUTO r ~~ ~ l~i
ALL OWNED AUTOS
I-- ~- ~ BODILY INJURY $
SCHEDULED AUTOS (Per person)
f-- 12004
f-- HIRED AUTOS :f BOOIL Y INJURY
(Per accident) $
f-- NON-oWNED AUTOS .J
\ -' PROPERTY DAMAGE
-r11 V Of CLf.AH~jf\1ER (Per accidant) $
RGE LIABILITY . PUBLIC AUTO ONLY - EA ACCIDENT $
"-
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
DESS LIABILITY EACH OCCURRENCE $
OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
B WORKERS COMPENSATION AND WVA7753374 OS/22/04 OS/22/05 X I wc ST~m:i--" 1 IOJ,tt-
EMPLOYERS' LIABILITY $100,000
E.L. EACH ACCIDENT
E.L DISEASE - EA EMPL OYEE $100,000
E.L DISEASE - POLICY LIMIT $500,000
C OTHER AEE197221 01 04 OS/29/04 OS/29/05 $1,000,000 Each Claim
!Professional $1,000,000 Ann Aggr
Liability
DESCRIPTION OF OPERATlONS/LOCATlONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Professional Liability is written on a claims made and reported basis.
CERTIFICATE HOLDER I I ADD ITIONAL INSURED ; INSURER LETTER: CANCELLATION
SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30.....- DAYS WRITTEN
Engineering Department NOTICETOTHE CERTIFICATE HOLDERNAMED TOTHE LEFT, BUT FAILURE TODOSOSHALL
Suite 220 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
PO Box 4748 REPRESENTATIVES.
Clearwater, FL 33758-4748 AUTHORIZED REPRESENTATIVE
I ~ h>.. ,:-:" " 10 ..
ACORD 25-5 (7/97)1 of 2
#M94315
KHK
@ ACORD CORPORATION 1988