CERTIFICATE OF LIABILITY INSURANCE (2)Client#: 3970
IONEEDM3
ACORD
CERTIFICATE OF LIABILITY INSURANCE DATE (MW
)
- 7/
31/2009
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ISU Suncoast Insurance Assoc QNLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P
O
Box 22668 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 & 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.
INSR
LTR 0%00'
NSR TYPE OF INSURANCE POLICY NUMBER DATE IMMFD IM PDATE MMM DpTION LIMITS
A GENERAL LIABILITY 66019511.902 06/30/09 06/30/10 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $1,000,000
CLAIMS MADE N OCCUR MED EXP (Any one person) $5,000
PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
POLICY PRO- LOC
JECT
E AUTOMOBILE LIABILITY BA19581_731 06/30109 06/30/10
X COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
ANY AUTO
ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
RECEIV ED
X HIRED AUTOS BODILY INJURY
X NON-OWNED AUTOS
' (Per accident) $
A
3 201
( 13
.
.
., PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY M ICK RECOR S AND AUTO ONLY - EA ACCIDENT $
ANY AUTO LE, ISLATIVE SRVC DEPT OTHER THAN EA ACC $
AUTO ONLY: AGG $
B EXCESS/UMBRELLA LIABILITY
_ CUP6513Y228 06/30/09 06/30/10 EACH OCCURRENCE $5,000,000
X
r
1
OCCUR
CLAIMS MADE AGGREGATE $5,000,000
$
DEDUCTIBLE $
X RETENTION $10,000 $
C WORKERS COMPENSATION AND
' UB6423YO38 06130/09 06130/10 X C Ulff 10TH-
EMPLOYERS
LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$1,000,000
OFFICER/MEMBER EXCLUDED?
E.L. DISEASE - EA EMPLOYEE
$1 000 ,000
If yas, 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.
Project: 2009 Engineer of Record
City of Clearwater is listed as additional Insured with respect to the General and Auto Liability policies.
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
Attn: City Clerk NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
PO Box 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Clearwater, FL 33758.4748 REPRESENTATIVES.
I AUTL1ORIZED REPRESEjdTATIVE?
V_9r?p eft 06_wta
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s
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.
m-umu 6v-0 tcuuiiua) 2 of 2 #5206048/M200008