CERTIFICATE OF LIABILITY INSURANCE (87)Client: 3103
TAMPSAY3
AC67D. CERTIFICATE OF LIABILITY INSURANCE 7/28/2009""""'
PRODUCER
ISU Suncoast Insurance Assoc
P.O. Box ZZ668 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 As Travelers Indemnity Co of Amer! 25666
Cardno TBE INSURER B: St. Paul Fire Er Marine Insuranc 24767
380 Park Place Blvd. Suite 300 INSURER a Travelers Indemnity Company of 25682
Clearwater, FL 33759 INSURER D: XL Specialty Insurance Company 37885
INSURER E: Travelers Indemnity Company 24791
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.
INUR
LTR ADD'
NS
TYPE OF INSURANCE
POLICY NUMBER
DATIE MFF DINE
PDATE MMID QDW EXPIRATION
LIMITS
A GENERAL LIABILITY 66018931_120 06130/09 09/30/09 EACH OCCURRENCE $1,000,000
MERCIAL GENERAL LIABILITY DAMAGE TO RENTED $1 000 0 0.
CLAIMS MADE 1 X OCCUR MED EXP (Any one person) $cj 000
X Contractors
V
lnd. PERSONAL & ADV INJURY $1 000 000
nt. Liability GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
1 M POLICY PROJECT - LOC
E AUTOMOBILE LIABILITY BA40631N538 06/30/09 09/30/09 COMBINED SINGLE LIMIT
X ANY AUTO (Ea accident) $1,000,000
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS
2001 (Per person) $
X HIRED AUTOS BODILY INJURY
P $
X NON-OWNED AUTOS er accident)
(
OFFIC AL RECORDS ND PROPERTY DAMAGE
LEGIS TIVE SRVCS EPT
(Per accident) $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
B EXCESSIUMBRELLA LIABILITY QK06501924 06/30/09 09/30/09 EACH OCCURRENCE $9,000,000
X OCCUR LICLAIMS MADE AGGREGATE M0001000
I DEDUCTIBLE $
X RETENTION $10,000
_
C WORKERS COMPENSATION AND UB6576Y111 06/30/09 09130109 X C STATU- OTH-
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$11000,000
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 DPR9617724 11126108 11/26/09 $5,000,000 per claim
Liability $5,000,000 annl aggr.
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Professional Liability is written on a claims made and reported basis.
City of Clearwater Is listed as additional insured with respect to the General, Auto and Excess Liability
policies. Waiver of subrogation in favor of the additional insured applies to the General, Auto and Excess
Liability policies. This Insurance is primary and non-contributory over any other insurance maintained by
certificate holder.
City of Clearwater
Attn: City Clerk
PO Box 4748
Clearwater, FL 33758.4748
I IUN T u
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 'in- 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
oft W&
AU1'F10RI RESESITATNLE
ACORD 25 (2001/08) 1 of 2 #S205489/M201433 BJM 0 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 25-5 (2007108) 2 of 2 #S2054891M201433