CERTIFICATE OF LIABILITY INSURANCE (108)Client#: 2962
SDIENVI3
ACORD- CERTIFICATE OF LIABILITY INSURANCE 08/28/2009 '
PRODUCER
ISU Suncoast Insurance Assoc
P.O. Box 22668 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
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: American Safety Indemnity Compa 25433
S D I Environmental Services, Inc. INSURER B: Travelers Indemnity Company 25658
3903 Premier North Drive INSURER c: Travelers Casualty and Surety C 19038
Tampa, FL 33618 INSURER D: Travelers Indemnity Co of Amerl 25666
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.
LTR
NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE
bA7E MM/DD/YY POLICY EXPIRATION
DATE MM/DD/YY LIMITS
A GENERAL LIABILITY ENVO10624095 09/02/09 09102/10 EACH OCCURRENCE $1,000.000
COMMERCIAL GENERAL LIABILITY DAMAGES f RE. occurrence) ENTED $50,000
CLAIMS MADE ? OCCUR MED EXP (Any one person) $5,000
n PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
- PRODUCTS - COMP/OP AGG $1 OOO OOO
RO LOC
POLICY P
JEC
1
D AUTOMOBILE LIABILITY BA2562LI4409 07/29/09 07/29110 COMBINED SINGLE LIMIT
•---^-•?° ?"
- :?
-
(Ea accident) S1000000
, ,
X ANY AUTO -
,
ALL OWNED AUTOS BODILY INJURY
. $
SCHEDULED AUTOS ' (Per person)
X HIRED AUTOS )?'p 2 BODILY INJURY
X
NOWOWNEDAUTOS
'..J
(Peraccidant) $
PROPERTY DAMAGE
E I
A J $
l_
OFFI?•l LEI
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
B EXCESS/UMBRELLA LABILITY CUP6416Y164 06130/09 06/30/10 EACH OCCURRENCE $1,000,000
X OCCUR EI CLAIMS MADE AGGREGATE $1,000,000
DEDUCTIBLE $
X RETENTION $10,000 $
C WORKERS COMPENSATION AND UB708ZY944' 09101109 Q9IO1I1 O - X
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1,000,000
OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1,000,000
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$1,000,000
A OTHER Professional ENVOI0624095 09/02/09 09/02/10 $1,000,000 per claim
Liability $1,000,000 annl aggr.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Professional Liability is written on a claims made and reported basis.
City of Clearwater
Attn: City Clerk
PO Box 4748
Clearwater, FL 33758.4748
N
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL .140 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES,
AUTF1gRIZED REPRES_ EpTATIVE
ACORD 25 (2001/08) 1 of 2 #S210336/M210332 MRL ® 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 (2001/08) 2 of 2 #S210336/M210332