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CERTIFICATE OF LIABILITY INSURANCE (86)r`Iionf f- 1A7AR Ar Incnno0 ACORU CERTIFICATE OF IABILITY INSURANCE DATE ""' , L 07 /24/2009 PRODUCER _ ,a THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISU Suncoast Insurance Assoc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P O Box 22668 - 2901 HOLDER. THIS CERTIFICATE DOES AMEND, EXTEND OR . . 2 A LTER THE COVERAGE AFFORDED BY THE H E POLICIES BELOW. Tampa, FL 33622-2668 813 289-5200 RECORDS GIFNLIL AND INSURERS AFFORDING COVERAGE NAIC # INSURED _ . SRVCS DEPT INSURER A: Old Dominion Insurance Company 40231 Robert Associates INSURER B. Travelers Casualty 8- Surety Co 19038 1935&U.S. Hwy 19 N INSURER C: XL Specialty Insurance Company 37885 Ste 101 INSURER D: Clearwater, FL 33764 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM /YY POLICY EXPIRATION DATE MM DD LIMITS A GENERAL LIABILITY BPG98417 07/22/09 07/22/10 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY _ D AMA MIS .or GE TO RENTED PRE ES I 'currence) 500,000 CLAIMS MADE F x1OCCUR MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG , $2,000,000 POLICY PRO-CT LOC JE A AUTOMOBILE LIABILITY 131 G98417 08/07/09 08/07/10 X' COMBINED SINGLE LIMIT (Ea accident) $1,000y000 . ANY. AUTO .ALL OWNED AUTOS BODILY INJUR SCHEDULED AUTOS .. Y (Per person) $- - X HIRED AUTOS BODILY N I JURY $ X NON OWNED AUTOS (Per accident) -- ,- - P ROPERTY DAMAGE $ .. (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY CUG98417 07/22/09 07/22/10 EACH OCCURRENCE $1 000,000 X OCCUR ? CLAIMS MADE AGGREGATE $1,000,000 DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND - -- ' UB708OY38509 - - 09/01109 09/01/10 .. -WC 57ATT& . OTH- M FIR `. - ..- - EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? E.L. DISEASE: - EA EMPLOYEE $500,000 If yes, describe under SPECIAL PROVISIONS below 171, DISEASE - POLICY LIMIT $500,000 C OTHER Professional DPR9680652 07120/09 07/20/10 $2,000,000 per claim Liability $2,000,000 annl aggr. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Professional Liability is claims made and reported. City of Clearwater is an additional insured w/respect to General Liability and Auto Liability. Waiver of Subrogation is included except for Workers Compensation. vim-.I I- 1vnI? rrv"Ur n I..ANt r-LLAI IUN ._ -1U WaYS Tor Non-payment City of Clearwater Attn: City Clerk P.O. Box 4748 Clearwater, FL 33758-4748 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _3.0_ 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 REPRESENTATIVES. AU ORIZED REPRE06-W- SS?TATIVE f1V A -mil M%1%jr%U AD tcuu HUD) 1 OT 2 #5205126/M205125 KEB © ACORD CORPORATION 1988 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. ACORD 25-S (2001/08) 2 of 2 #S205126/M205125