CERTIFICATE OF LIABILITY INSURANCE (3)ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DONYYY)
. 8/3/2009
PRODUCER Phone: 727-461-6044 Fax: 727-442-7695 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Brown & Brown Insurance - Clearwater ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 2456
Box HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
S
it
660 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
u
e
Clearwater FL 33757-2456
INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURERA:National Fire Ina of Hartford 0478
King Engineeri ng Assoc., Inc.
4921 M
i
l H
St
30 INSURER B: TrgInsipgrt at ion I 0. 20494
emor
a
em wy
e
0
Tampa
33634 INSURERC: alle For insurance Com 0508
INSURERD:Continental Casualty 044
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.
INSR DO'
DFINSURANCE
POLICY NUMBER POLICYEFFECTIVE POLICY EXPIRATION
LIMITS
A X GENERAL LIABILITY 1 / 1 / 2 0 0 9 1 / 1 /-2 010 -. OCCURRENCE- - - -' $ - 0 . -.,..: ..
X ? M MERCIAL GENERAL LIABILITY PREMISES Ee occu $ 5 0 0 0 0
J CLAIMS MADE X] OCCUR MED EXP An ona rson) $ 5 0
XCTT Tncluded PERSONAL&ADVINJURY $ 1 0 000
-
X lContractual GENERAL AGGREGATE 12
000
000
,
,
GEN'LAGGREGATE LIMIT APPLIES PER; PRODUCTS -COMPIOPAGG $ 2 00
RO- LOC
POLICY P
JFQ-T
A AU TOMOBILE LIABILITY 02066728232 1/1/2009 1/1/2010 COMBINED SINGLE LIMIT
ANY AUTO
7 (Ea accident) $1,000,000
ALL AWNED AUT05 E /
f BODILY IN
U
Y
t J
R $
X SCHEDULEDAUTOS (Per person)
X HIREDAUTOS a?
J
J
L
BODILY INJURY
$
X NON-OWNEDAUTOS (Per accident)
OFFIC RDS
IAL RECO AND PROPERTY DAMAGE $
(Per accldenp
GARA0 LIABILITY /+
LEGIS TIVE S AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHERTHAN EAACC $
AUTO ONLY: AGG $
B EXCESS/UMBRELLALIABILITY C2066728246 1/1/2009 1/1/2010 EACH OCCURRENCE $5,000,000
X OCCUR CLAIMS MADE AGGREGATE $5,000,00Q
0 DEDUCTIBLE $
X
RETENTION $ 0
$
C WORKERS COMPENSATION AND
..-
' W C 16 3 6 7 2 015 1 / 1 / 2 0 0 9. _ - 1 / 1 / 2 010 X WC STATU- 0TH-
- EMPLOYERVLIABILITY
-
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1 O
OFFICER/MEMBER EXCLUDED?
If
d
ib E.L. DISEASE - EA EMPLOYEE $ 0 0 0 0 0
yyes
esa
eunder
SPE
CIAL PROVISIONS below E.L. DISEASE-POLICY LIMIT $
D OTHER
Professional E&o EH113805181
1/1/2009
1/1/2010 Per Occurrence 5000000
Retro 1-1-1994
Aggregate 5000000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
ertificate Holder is additional insured per the terms of the liability policy with respect to Bodily Injury or
Property Damage arising from the work performed by the named insured per form G140331A (attached). Waiver of
Subrogation for General Liability is included in blanket form. * 10 Day Notice for Non Payment of Premium
overage is primary & Non Contributory to any policies held by the certificate holder as required by written contract.
%PM194C1.1 MI Him
City of Clearwater
Attn: City Clerk
PO 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 30 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.
AUTHORIZED REPRESENTATIVE
^"""" `V %`Vv 1''VW1 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.
AL,U U Lb tauu11us)
CNA
G-140331-A
(Ed. 01101)
IMPORTANT: THIS ENDORSEMENT CONTAINS DUTIES THAT APPLY TO THE ADDITIONAL
INSURED IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT. SEE PARAGRAPH
C.1. OF THIS ENDORSEMENT FOR THESE DUTIES.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTOR'S SCHEDULED AND BLANKET ADDITIONAL INSURED
ENDORSEMENT WITH PRODUCTS-COMPLETED OPERATIONS COVERAGE
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization: Designated Project:
(Coverage under this endorsement is not affected by an entry or lack of entry in the Schedule above.)
A. WHO IS AN INSURED (Section II) is amended to 3.
include as an insured any person or organization,
including any person or organization shown in the
schedule above, (called additional insured) whom you
are required to add as an additional insured on this
policy under a written contract or written agreement;
but the written contract or written agreement must be:
1. Currently in effect or becoming effective during the
term of this policy; and
d--Pty?n}ury," ,PropertY-=-
damage," or "personal and advertising injury".
s B. The insurance provided to the additional insured is
limited as follows:
1. That person or organization is an additional
insured solely for liability due to your negligence
specifically resulting from "your work" for the
additional insured which is the subject of the
written contract or written agreement. No
coverage applies to liability resulting from the sole
?=- negligence of the additional insured.
2. The Limits of Insurance applicable to the C
additional insured are those specified in the
written contract or written agreement or in the
_ Declarations of this policy, whichever is less.
These Limits of Insurance are inclusive of, and not
_ in addition to, the Limits of Insurance shown in the
Declarations.
The coverage provided to the additional insured
by this endorsement and paragraph f. of the
definition of "insured contract" under
DEFINITIONS (Section V) do not apply to "bodily
injury" or "property damage" arising out of the
"products-completed operations hazard" unless
required by the written contract or written
agreement.
4. The insurance provided to the additional insured
does not apply to "bodily injury," "property
datrtag?,"-ter--"personal- end.. adver icing-...injury' _---`
arising out of an architect's, engineer's, or
surveyor's rendering of or failure to render any
professional services including:
a. The preparing, approving, or failing to prepare
or approve maps, shop drawings, opinions,
reports, surveys, field orders, change orders
or drawings and specifications; and
b. Supervisory, or inspection activities performed
as part of any related architectural or
engineering activities.
As respects the coverage provided under this
endorsement, SECTION IV - COMMERCIAL.
GENERAL LIABILITY CONDITIONS are amended as
follows:
1. The following is added to the Duties In The Event
of Occurrence, Offense, Claim or Suit Condition:
G-140331-A Page 1 of 2
(Ed. 01/01)
G-140331-A
(Ed. 01/01)
e. An additional insured under this endorsement
will as soon as practicable:
(1) Give written notice of an occurrence or an
offense to us which may result in a claim
or "suit" under this insurance;
(2) Tender the defense and indemnity of any
claim or "suit" to any other insurer which
also has insurance for a loss we cover
under this Coverage Part; and
(3) Agree to make available any other
insurance which the additional insured
has for a loss we cover under this
_-:Coveragef?Far
f. We have no duty to defend or indemnify an
additional insured under this endorsement
until we receive written notice of a claim or
"suit" from the additional insured.
2. Paragraph 4.b. of the Other Insurance Condition is
deleted and replaced with the following:
4. Other Insurance
b. Excess Insurance
This insurance is excess over any other
insurance naming the additional insured
as an insured whether primary, excess,
contingent or on any other basis unless a
written contract or written agreement
._-specificaily-equires_thatthis-insurance-be...
either primary or primary and
noncontributing.
G-140331-A
(Ed. 01101)
Page 2 of 2