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CERTIFICATE OF LIABILITY INSURANCE (104)rliwnf#- .197n JONEEDM3 ACORUM CERTIFICATE OF LIABILITY INSURANCE 06/26/2009 PRODUCER ISU Suncoast Insurance Assoc P.O. Box 22668 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. Tampa, FL 33622-2668 813 289-5200 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Travelers Indemnity Company of 25682 Jones Edmunds Er Associates, Inc. INSURER B: Travelers Indemnity Company 25658 730 N.E. Waldo Road INSURER c: Travelers Casualty and Surety C 19038 Gainesville, FL 32641 INSURER D: XL Specialty Insurance Company 37885 INSURER E: Travelers Indemnity Co of Ameri 25666 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. LTR SR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM DD/YY POLICY EXPIRATION DATE MM/DD/YY LIMITS A GENERAL LIABILITY 66019511-902 06/30/09 06/30/10 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY S .c DAMAGE To RENTED S 1 currence) $1,000,000 CLAIMS MADE 51OCCUR MED EXP (Any one person) $5,000 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 FEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 R LOC POLICY P JECT E AUTOMOBILE LIABILITY BA195BL731 06/30/09 06/30/10 COMBINED SINGLE LIMIT E id t $1 000 000 X ANY AUTO a acc en ) ( , > ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS } LL ,?7 1.? (Per person) $ X HIRED AUTOS ?? B SS t t I BODILY INJURY X NON-OWNED AUTOS d' r ?•. 7 1 }.; , (Per accident) $ JUN ... L? PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY =l?•IA( R? _r ='.'Y AUTO ONLY - EA ACCIDENT $ ANY AUTO Us OTHER THAN EA ACC $ R AUTO ONLY: AGG $ B EXCESS/UMBRELLA LIABILITY CUP6513Y228 06130/09 06/30110 EACH OCCURRENCE $510001000 X OCCUR FICLAIMS MADE AGGREGATE s5,000,000 $ DEDUCTIBLE $ .._.:. ..__.: - -X' RETENTIUN.: $ 10,000- . . .. .:. ... . . . ...._Y-. .. .... _ .. _ -. _ .:. -- ---•. __. _. .. .,_,_. .. .. _, =-- --- ------ - -$ --- - ,-- - C WORKERS COMPENSATION AND UB6423YO38 06/30/09 06/30/10 I Y X C sTA IT CER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 D OTHER Professional DPR9680446 06/30/09 06/30/10 $5,000,000 per claim Liability $5,000,000 annl aggr. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Professional Liability is written on a claims made and reported basis. 2006 Engineer of RecordCertificate holder is listed as an additional insured with respects to the General Liability and automobile policies. CERTIFICATE HOLDER CANCEU.-AiION iu uays Tor non-raymeni City of Clearwater Attn: City Cleric P O Box 4748 Clearwater, FL 33758 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ?0_ 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 A .;IZEb REPRESEjJTATIVE V-% ACORD 25 (2001/08) 1 of 2 #S200020/M200008 MRL © ACORD CORPORATION 1988 I IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ? UKU ZO-1 tzuu11ual 2 of 2 #S200020/M200008