CERTIFICATE OF LIABILITY INSURANCE (110)
ACORD. CERTIFICATE OF LIABILITY INSURANCE 9/30/2010 D _TE (MMIDD/YYYY)
FA 9/22/2009
PRODUCER Lockton Companies, LLC-1 Kansas City
444 W. 47th Street, Suite 900
Kansas City MO 64112-1906
816
960
9000 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.
(
)
- INSURERS AFFORDING COVERAGE NAIC #
INSURED POST
SCHUH AND JERNIGAN, INC.
BUCKLEY INSURER A: LLOYDS OF LONDON A XV
,
,
1307320 DBA PBS&J INSURER B :
2001 NW 107 AVENUE
MIAMI FL 33172-2507
INSURER C :
INSURER D :
INSURER E :
R C TI KATE MOLDER.
COVERAGES PD INSURERrSI.- AUI yr HORIZED REPRESEUMIIVE PRODU6;RjNiME
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE F'OLI(:T VLKIUU muiuAIED. NuIwIIna1ANUInw
TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
ANY REQUIREMENT
,
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
LTR ADD'L
INSRD
TYPE OF INSURANCE
POLICY NUMBER POLICY EFFECTIVE
DATE (MM/DD/YY) POLICY EXPIRATION
DATE (MM/DD/YY)
LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ XxxxxxX
DAGE TO RENTED
EM
XXXXXXX
COMMERCIAL GENERAL LIABILITY PRR
SES Ea occu e $
CLAIMS MADE D OCCUR NOT APPLICABLE MED EXP (Any one person) $ xxxxXXX
PERSONAL & ADV INJURY $ XXXXXXX
GENERAL AGGREGATE $ XXXXXXX
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ XXXXXXX
PRO-
POLICY JECT LOC
^
AUT
OMOBILE LIABILITY
I ? '
^i
?
'i •
(
INGLE LIMIT
COMBINED
$ XXXXXXX
ANY AUTO t I
I'
j?
--•-- )
- E
?.
ALL OWNED AUTOS D
RY
(O DULY IN'U
$ XXXXXXX
SCHEDULED AUTOS NOT APPLICABLE
HIRED AUTOS j BODILY INJURY $ xxxXXxx
NON-OWNED AUTOS ? (Per accident)
l
)
Of `) IA! P .,
TIVE SRVCS p
T PROPERTY DAMAGE $ XXXXXXX
??(•il? (Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ XXXXXXX
ANY AUTO NOT APPLICABLE OTHER THAN EA ACC $ XXXXXXX
AUTO ONLY: AGG $ XXXXXXX
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ XXXXXXX
OCCUR r-1 CLAIMS MADE AGGREGATE $ XXXXXXX
NOT APPLICABLE $ XXXXXXX
UMBRELLA
171
FORM
DEDUCTIBLE $ xxy-xX.XX
XXXXXXX
$
_.. R.?TENTION.- $- - - -..--...- --- - -- .
STATU- TH-
WC
WORKERS COMPENSATION AND OR ER
T
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT XxXXx
$
ANY PROPRIETORIPARTNER/EXECUTIVE NOT APPLICABLE XXXXXXX
OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
SPECIAL- PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$ XXXXXXX
A OTHER LDUSA0900811 9/30/2009 9/30/2010 $1,000,000 EACH CLAIM & $1,000,000
A CLAIMS-MADE FORM ANNUAL AGGREGATE.
PROFESSIONALIPOLLUTION 11/11/1961 RETRODATE.
LIABILITY
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
RE: 2009-2012 CITY OF CLEARWATER ENGINEER OF RECORD.
I-Aklf' I I ATlnnl
" „10607446?v SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF CLEARWATER DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
ATTN: CITY CLERK NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
PO BOX 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
CLEARWATER FL 33758-4748
REPRESENTATIVES.
AUTHORIZED REPRESE E
ACORD 26 (2001/08) For questions regarding this certlllcate, contact the number listed in the 'Producer, section above. IF of w AL:UKL1 t;UKYUKA I IUN I V00