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CERTIFICATE OF LIABILITY INSURANCE (109)ACORD CERTIFICATE OF LIABILITY INSURANCE OPID EA DATE(MM7DD/YYY ) RnTCFBAR 9 o9/0l/09 PRODUCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BB&T - J Rolfe Davis Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 4927 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Orlando FL 32802-4927 Phone: 407-691-9600 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Hartford Casualty Insurance Co 29424 INSURER B: Zurich North American Baker Barrios Architects, Inc. INSURER C: v 189 S. Orange Avenue,Ste #1700 Orlando FL 32801 INSURER D: - 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. V LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY 21SBA UF6297 11/15/08 11115109 UANG4GET0-R'ENTEU--" PREMISES (Eaoccurence $ 1000000 CLAIMS MADE OCCUR MED EXP (Any one person) $10000 PERSONAL & ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2000000 POLICY PRO- JECT X LOC AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS ID _.-.- (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS . (Per accident) $ PROPERTY DAMAGE 111 (Per accident) $ GARAGE LIABILIT Y AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5000000 A X] OCCUR CLAIMSMADE 21SBA UF6297 11/15/08 11/15/09 AGGREGATE $ 5000000 $ DEDUCTIBLE $ 'X RETENTION $ 10000 $ WORKERS COMPENSATION AND X TORYLIMITS E R _ B EMPLOYERS' LIABILITY ANY PROPRIETOR WC0253005502 09/01/09 09/01/10 E.L. EACH ACCIDENT $500000 OFFICEWMEMBEREXCLUDED? v- -El- ,0 .04 . iffier Unde7--.--.--.. - S ECIP ALP OVISIONS below E.L. DISEASE - POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION CITYCLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City of Clearwater Attn: City Clerk IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR P O Sox 4758 REPRESENTATIVES. Clearwater FL 33758 J A19IZE REPRESENTATIVE ACORD 25 (2001/08) © 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 (2001/08)