CERTIFICATE OF LIABILITY INSURANCE (107)ACORU CERTIFICATE OF LIABILITY INSURANCE I I-)
wI THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
BF &T InSlUrance.ASUra ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE.
4309 Itlw rt«r Blvd. Ilte 300 HOLDER. THIS CERTIFICATE DOES NOT AMF-ND, LXTLNC) O
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Duncctrr NC 27703 I ns. - -
919 281-4500 - INSURERS AFFORDING COVFRA'3F NAIL
INSURED
McKim & Creed FA
1730 Varsity Dr.., Ste. 500
R,aicigh, NC 27606
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Lx i I 10,000
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4 000,0000
4,000,000
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1,000,000
41,00a.cot1
FHrIFIHA'F HLILUEtH
City of Cle?irwater, Engineering
Dept, St(: 220
Attn: Dir?i Katsoucgrakis
PCB! Box 4740
Clearwater, FL 33756-4782
ACOR 25 (2001108) 1 of 2 #540 ;1113n1M4029931
Clncilm'It! Il 'trance cl'-)m zany 106177
FFVA Mutkiaf Insurance Cwllpany 10385
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I'i t 1g ',.. Y L , Iy I_j 1.
AIJ7 :rJ t NF I t hTAIL._
is Tor Non-vaymenT.
_1CIES BE f ar;rl I i F F-FORE THE EXPIRATION
-- ILL FNDEAVOI ?:.I ^,1!:,L DAYS WRI'rTEN
R NAMED TO THE IF rT, Hy: I FAILUJRE TO DO SO SHALL
r" r ANY KID ? UP :,r, r:,, . ,1, p,L- h I "p AC'EN'r5 OR
JL () ACORD CORPORATION 1981:
Clipnt#- 292011
AOMrKIMrRF
ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/Y
YY)
0
9/04/2009
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
BB&T Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
3318 West Friendly Ave. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
, ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Ste. 400
Greensboro, NC 27410 INSURERS AFFORDING COVERAGE NAIC #
INSURED
INSURERA: XL Specialty Insurance Company
37885
McKim &Creed, P.A
P.A.
INSURER B:
243 North Front Street
INSURER C:
P.O. Box 806
INSURER D:
Wilmington, NC 28402
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-
IN SR
LTR DD'
NSR
TYPE OF INSURANCE
POLICY NUMBER POLICY EFFECTIVE
/D /YY POLICY EXPIRATION
DATE MM/DDNY
LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
i occurrence) $
- CLAIMS MADE-- 0 OCCUR MED EXP (Anyone person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
POLICY JPECj LOC
AUT OMOBILE LIABILITY \ J COMBINEDSINGLE LIMIT
ANY AUTO ????
{1i1
(Ea accident) $
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS
1` 704
(Per person) $
HIRED AUTOS
BODILY INJURY
NON-OWNED AUTOS
OFFI
IAL RECORD
p?
AND
(Per accident) $
LEGI LATIVE SRVCS DEPT PROPERTY DAMAGE
(Per accident) $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY
- EACH OCCURRENCE $
OCCUR F
1 CLAIMS MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND WC STA IT OTH-
TORY FR
- EMPLOYERS' LIABILITY
-PRAPRIETOft$%RTNE' .. ..
R1EXE>;tfTiVf""r
.?,-.__ .
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$
A OTHER Professional
Liability DPR9681076 09/05/09 09/05/10 $5,000,000 Per Claim
$7,000,000 Aggregate
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
%,r-m r rrlw M 1 r_ nULUCK C:ANULLLA I IUN 'IU IJavs Tor Non-YBVment
City of Clearwater
Attn: City Clerk
P.O. 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 _1_ 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.
AO IZED REP ESFfIT/IV
ACORD 25 (2001/08) 1 of 2 #S4032944/M4032651 CC1 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-S (2001108) 2 of 2 #S40329"M4032651