CERTIFICATE OF LIABILITY INSURANCE
~ ~
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNY)
OS/27/05
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Suncoast Insurance Associates ONLY 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
INSURED INSURER A: United States Fidelity & Guaranty
Grimail Crawford, Inc. INSURER s: St. Paul Fire & Marine
5444 Bay Center Dr., Suite 204 INSURER c: Hudson Insurance Co.
Tampa, FL 33609 INSURER D:
I INSURER E:
Client#. 6108
GRIMCRA3
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 TYPE OF INSURANCE POLICY NUMBER "g~.9J.~f~~~ POLICY EXPIRATION LIMITS
LTR D
A ~NERAL LIABILITY BK01231322 10/14/04 10/14/05 EACH OCCURRENCE $1.000000
X COM M ERCIAL GENERAL L1AB ILlTY FIRE DAMAGE (Anyone fire) $300 000
I CLAIMS MADE W OCCUR MED EXP (Anyone person) $10000
- PERSONAL & ADV INJURY $1,000,000
- GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIM IT APPLIES PER: PRODUCTS -COMP/OP AGG $2,000,000
I POLICY n ~~g: n LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $
ANY AUTO (Ea accident)
-
- ALL OWNED AUTOS BODILY INJURY
(Per person) $
- SCHEDULED AUTOS
- HIRED AUTOS BODILY INJURY
(Per accident) $
- NON-oWNED AUTOS
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
:::J OCCUR D CLAIMS MADE AGGREGATE $
$
=l DEDUCTIBLE $
RETENTION $ $
X l~~~I~JI~s T 'lOJ~- ----..---
B WVA7753374 OS/22/05 OS/22/06 - _._ __ - __ - __n__
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY $100,000
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPL OYEE $100,000
E.L. DISEASE - POLICY LIMIT $500,000
C OTHER AEE7137100 OS/29/05 OS/29/06 $1,000,000 Each Claim
Professional $1,000,000 Ann Aggr
Liability
DESCRIPTION OF OPERATIONSlLOCA TIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Professional Liability is written on a claims made and reported basis.
CERTIFICATE HOLDER I I ADDIT1ONALINSURED'INSURERLETTER: CANCELLATION
SHOULD ANYOFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL30.-DAYSWRITTEN
Engineering Department NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUTFAlLURE TODOSOSHALL
Suite 220 1M POSE NO OB LIGATION OR L1ABILITYOF ANY KIND UPON TH E INSURER,ITS AGENTS OR
PO Box 4748 REPRESENTATIVES.
Clearwater, FL 33758-4748 AUTHORIZED REPRESENTATIVE
I .J':J..1 h\. f'v II. j IC} --.
ACORD 25-8 (7/97)1 of 2
#M105484
KHK
@ ACORD CORPORATION 1988
ct.
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.
ACORD25-8(7/97)2 of 2 #MI05484