CERTIFICATE OF LIABILITY INSURANCE (113) yy)
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DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 09/29/2009
PRODUCER
Aon Risk Insurance Services West, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
Portland Oregon Office AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
851 SW 6th Avenue CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
Suite 385 COVERAGE AFFORDED BY THE POLICIES BELOW. '4
Portland OR 97204-1309 USA 000
PHONE-(503) 224-9700 v- 503 295-0923 INSURERS AFFORDING COVERAGE NAIC # r6"-'
INSURED
TBE Group, Inc. Cardno TBE
380 PARK PLACE BLVD., SUITE 300
CLEARWATER FL 33579 USA
C_0VF.RAGRS
INSURER A: American Economy Ins Co 19690
INSURER B: Charter Oak Fire Ins Co
25615 Ir
INSURER C: Travelers Property Cas Co of America 25674
INSURER D: Great American insurance co. 16691 7~.,
a?
1 b
INSURER E: Hartford Casualty Insurance CO 29424 p
SIR aoolies Der terms and conditions of the Dolicv
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDTT70N 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. LIMITS SHOWN ARE AS REQUESTED
INSR ADD'
LTR INS TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
ATE M/DD/YYYY DATE(MM/DDNYM
RALLIABILITY 68018931.12009 09/30/2009 09/30/2010 EACH OCCURRENCE 51,000,000
C
COMMERCIALGENERAI. LIABILITY GL (AOS)
6801912L57A09
09/30/2009
09/30/2030
DAMAGE TO RENTED
$1,000,000
N PREMISES (Ea occurrcnee)
CLAIMS MADE ® OCCUR GL (CA) y one person
B
6802248L72AO9
09/30/2009
09/30/2010
GL (FL) PERSONAL & ADV INJURY $1,000,000
C ? CP1920L96209 09/30/2009 09/30/2010 GENERAL AGGREGATE $2
000
000
GL ,
,
GENL AGGREGATE LIMIT APPLIES PER:
PRODUCTS -COMP/OP AGG
included
? POLICY E PRO- ? LOC
JECT
A AUTOMOBILE LIABILITY 02-CE-213191-10 09/30/2009 09/30/2010 COMBINED SINGLE LIMIT
ANY AUTO Auto (VA) (Ea accident) $1,000,000
A 01-CI-285296-10 09/30/2009 09/30/2010
ALL OWNED AUTOS AUtO (NJ)
BODILY INJURY
A
X
SCHEDULED AUTOS
E-213201-10
02-
09/30/2009
09/30/2010
(Per person)
C
AUt (LA)
A HIRED AUTOS 02-CE-2131 U;-10 09/30/2010 BODILY INJURY
NON OWNED AUTOS AutO (GA) L; D 1F'
Ir (Per accident)
D . "...'" ....... . .
e..
PROPERTY DAMAGE
(Per accident)
?
GARAGE LIABILITY -? -•,
, AUTO ONLY - EA ACCIDENT
H ANY AUTO
G :
-
- I
OTHER THAN EA ACC
..
I _?LA I
_
F -,cs!
Sri, ,
`
AUTO ONLY
AGG
D EXCESS / UMBRELLA LIABILITY 7000016410-00 09/30/2009 A/30/2010 EACH OCCURRENCE
El OCCUR ? CLAIMS MADE AGGREGATE $15,000,000
10
000
,
RETENTION $
E 5 WELR1 X WC STATU- OTH-
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
N
E.L. EACH ACCIDENT
$1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBTREXCLUDED?
(Mandatar
in NH)
E.L. DISEASE-EA EMPLOYEE
$1,000,000
y E.L. DISEASE-POLICY LIMIT $1,000,000
If es, descnbe under SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VETJTCLES/EXCLUSTONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
City of Clearwater is listed as additional insured with respect to the General, Auto and Excess Liability
policies. waiver of subrogation in favor of the additional insured applies to the General, Auto and Excess
Liability policies. This insurance is primary and non-contributory over any other insurance maintained by
CERTIFICATE HOLDER CANCELLATION
city of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Attn : City Clerk DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
PO BOX 4748 30 DAYS WRITTEN NOTICE TO THE CERTIFICA'T'E HOLDER NAMED TO THE LEFT,
Clearwater FL 33758-4748 USA BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ??i?Jfid lc.7sts?iasA?
ACORD 25 (2009/01) 01989-2009 ACORD CORPORATION. All rights reserve
The ACORD name and logo are registered marks of ACORD
Z
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
This Certificate of Insurance 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 (2009/01)
Attachment to ACORD Certificate for TBE Group, inc. Cardno TBE
The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage
afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the policy.
INSURED
TBE Group, Inc. Cardno TBE
380 PARK PLACE BLVD., SUITE 300
CLEARWATER FL 33579 USA
INSURER
INSURER
INSURER
INSURER
ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD
certificate form for policy limits.
INSR
LTR ADD'L
INSRD
TYPE OF INSURANCE POLICY NUMBER
POLICY DESCRIPTION POLICY
EFFECTIVE
DATE POLICY
EXPIRATION
DATE
LIMITS
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
certificate holder.
Certificate No : 570036297315
,)nno
CERTIFICATE OF LIABILITY INSURANCE DATE 1 n /n? /z oo9
?.? 1o/oz
PRODUCER
Aon Risk insurance Services West, Inc.
Portland Oregon Office
851 SW 6th Avenue
Suite 385
Portland OR 97204-1309 USA
PIIONE- 503 224-9700 FAM' 503 2'.
INSURED
TBE Group, Inc. Cardno TBE
380 PARK PLACE BLVD., SUITE 300
CLEARWATER FL 33579 USA
C.OVERAr:RC
rHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
,ND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
ZERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE 1-n
OVERAGE AFFORDED BY THE POLICIES BELOW. ,r-I
ao
INSURERS AFFORDING COVERAGE NAIC # r
INSURER A: American Economy ins CO
INSURER B: charter Oak Fire Ins Co
INSURERC: Travelers Property Cas Co Of America
INSURER D: Great American Insurance Co.
INSURERS: Hartford casualty insurance CO
SIR annliPs nPr terms and rnnditinnc r
19690
25615
25674 aA,
b
16691 ,?,
m
29424 0
tha nnlirv
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- LIMITS SHOWN ARE AS REQUESTED
INSR ADD'
LTR INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
ATE MM/DD/YYYY DATE MM/DD
C NERAL LIABILITY 68018931-12009
GL (
OS) 09/30/2009 09/30/2010 EACH OCCURRENCE $1,000,000
A
C COMMERCIAL GENERAL LIABILITY
6801912L.57A09
09/30/2009
09/30/2010 DAMAGE TO RENTED $1,000.000
GL (CA) _ PREMISES (Eft occurrmcc)
CLAIMS MADE ® OCCUR
6802248
72
09
09
30
2009 MED .X f v one person $5,000
B A
1-
GL (FL) /
/ 09/30/2010
PERSONAL & ADVTNJURY
$1,000,000
?
C PACP1920L96209 09/30/2009 09/30/2010 GENERAL AGGREGATE $2
000
000
GL (TX) ,
,
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS -COMP/OP AGG
Included
PRO-
POLICY
11 ® LOC
JECT
A AUTOMOBILE LIABILITY 02-CE-213172-10 09/30/2009 09/30/2010
Auto (AOS
) COMBINED SINGLE LIMIT
X ANY AUTO , (Ea accident) $1,000,000
A 02-CE-213191-10 09/30/2009 09/30/2010
ALL OWNED AUTOS Auto (VA) BODILY INJURY
A SCHEDULED AUTOS 01-CI-285296-10 09/30/2009 09/30/Z010 (Perperson)
Auto (NJ)
A HIRED AUTOS 02-CE-213201-10 09/30/2009 09/30/2010 BODILY INJURY
A NON OWNED AUTOS Auto (LA)
02-CE-213192-10
0
` 30
00
(?
3
(Per accident)
Auto (GA)
g
0 L
OS
0
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY :, iJ
? AUTO ONLY - EA ACCIDENT
...r
ANY AUTO
OTHER THAN EA ACC
FICIAL RECC), L'I:i AUTO ONLY:
AGG
D EXCESS / UMBRELLA LIABILITY TuuOO16410-00 EACH OCCURRENCE $15 on=,
El OCCUR ? CLAIMS MADE AGGREGATE $15,000,000
_. _
. D
EDUCTi
BLE _.
_?.
-
`-
-
- ---
00 -. ... _
_-.--
..$10
.
RETENTI
DN
E
WORKERS COMPENSATION AND
' 52WELRIS09 9 X WC STATU- OTH-
EMPLOYERS
LLABILITY
ANY PROPRIETOR /PARTNER /EXECUTIVE
E.L- EACH ACCIDENT
$1,000,000
OFFICER/MEMBER EXCLUDED? E.L. DISEASE-EA EMPLOYEE S1
000
000
(Mandatory in NH) ,
,
If s, describe under SPECIAL PROVISIONS below E.L. DISEASE-POLICY LIMIT $1,000,000
OTHER
DESCRIPTION Of OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
City of Clearwater is listed as additional insured with respect to the General, Auto and Excess Liability
policies. Waiver of subrogation in favor of the additional insured applies to the General, Auto and Excess
Liability policies. This insurance is primary and non-contributory over any other insurance maintained by
Lok,X I I V JUA IL E riOLOJEM CANCELLATION -
city of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Attn : City Clerk DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
PO BOX 4748 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Clearwater FL 33758-4748 USA BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. -
AUTHORIZED REPRESENTATIVE ._ 10iraealsal?ea
ACORD 25 (2009/01) (01988-2009 ACORD CORPORATION. All rights reserved
The ACORD name and logo are registered marks of ACORD
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
This Certificate of Insurance 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 (2009/01)
Attachment to ACO" Certificate for TBE Group, Inc. Cardno TBE
The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage
afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the policy.
INSURED
TBE Group, Inc. Cardno TBE
380 PARK PLACE BLVD., SUITE 300
CLEARWATER FL 33579 USA
INSURER
INSURER
INSURER
INSURER
INSURER
ADDITIONAL POLICIES If a policy below does not include limit information,-refer to the corresponding policy on the ACORD
certificate form for policy limits.
INSR
LTR ADD'L
INSRD
TYPE, OF INSURANCE POLICY NUMBER
POLICY DESCRIPTION POLICY
EFFECTIVE
DATE POLICY
EXPIRATION
DATE
LIMITS
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
certificate holder.
Certificate No : 570036411720