CERTIFICATE OF LIABILITY INSURANCE (14)
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
12/13/2005
PRODUCER (248)519-1400 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Guy Hurley Blaser and Heuer, LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1080 Kirts Blvd. , Suite 500 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
Troy MI 48084 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A Travelers Prop & Casual tv
Walbridge Aldinger Company INSURER B: Travelers Indemni tv of CT
Attn: Dave Belica INSURER C: Axis Special tv Ins Co
613 Abbott Street INSURER D: Great American Assurance
Detroit MI 48226 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 ADD'L POLICY EFFECTIVE POLICY EXPIRATION
LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DDNY) DATE (MM/DDNY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
- ~~~~~H9E~~~~~nce) 300,000
X COMMERCIAL GENERAL LIABILITY $
A I CLAIMS MADE [~] OCCUR RTC2JC0131J77l6TIL06 1/1/2006 1/1/2007 MED EXP (Anv one oerson) $ 5,000
X X C U Coverage Incl PERSONAL & ADV INJURY $ 2,000,000
GENERAL AGGREGATE $ 2,000,000
n'L AGGRE~E LIMIT nES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
POLICY X r;~8T LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000
X ANY AUTO (Ea accident)
I--
A I-- ALL OWNED AUTOS RTC2JCAP131J7728TIL06 1/1/2006 1/1/2007 BODILY INJURY
(Per person) $
I-- SCHEDULED AUTOS
~ HIRED AUTOS BODILY INJURY $
X NON.OWNED AUTOS (Per accident)
I--
I-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
==1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A EXCESS/UMBRELLA LIABILITY RTSMJCUP131J773ATIL06 1/1/2006 1/1/2007 EACH OCCURRENCE $ 5,000,000
~ OCCUR D CLAIMS MADE AGGREGATE $ 5,000,000
$
C I DE[).VCTIB.LJo..._' -.--,------ .0" ..J;:AU7_200'-OLQJ./2.o..o~_ 'C_'.-' - 1./ 1 L?99_6 1./]0.12,.007 _ - .$.. - 5,0.0.0,000
X RETENTION $10,000 $ 5,000,000
1/1/2006 1/1/2007 T we STATU- I IOTH-
A WORKERS COMPENSATION AND RTRJUBS071B66606 X TORY LIMITS ER
EMPLOYERS' LIABILITY 1,000,000
ANY PROPRIETOR/PARTNERlEXECUTIVE EL EACH ACCIDENT $
B OFFICER/MEMBER EXCLUDED? RTC2EUBS071B64206 1/1/2006 1/1/2007 E.L DISEASE - EA EMPLOYEE $ 1,000,000
If yes, describe under $ 1,000,000
SPECIAL PROVISIONS below E.L DISEASE - POLICY LIMIT
D OTHER Excess/Umbrella EXC92S1162 1/1/2006 1/1/2007 Each Occurrence 25,000,000
Liability Aggregate 25,000,000
A Contractors Floater QT660S4S6B40l 1/1/2006 1/1/2007 Leased/Rented 500,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Re: Richard A, Marshall CGCOS9863
CERTIFICATE HOLDER
CANCELLATION
City of Clearwater
P.O. Box 47448
Clearwater, FL 34618
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
@ ACORD CORPORATION 1988
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ACORD 25 (2001/08)
ftTM- INS025 (010B).05
ELECTRONIC LASER FORMS, INC. - (800)327-0545