CERTIFICATE OF LIABILITY INSURANCE (2)_?'l DATE
NUDD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
09/29/
9rz9/zoo9
PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION
Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1166 Avenue of the Americas HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
New York, NY 10036 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Attn: NewYork.Certs@Marsh.Com Fax 212-948-0500
109513-ALL-CAS-09-10 INSURERS AFFORDING COVERAGE NAIC #
INSURED
PRICEWATERHOUSECOOPERS
LLP
National Union Fire Ins. Co" of Pittsburgh, PA
INSURERA
19445
300 MADISON AVENUE INSURER B[ New Hampshire Insurance Company 23841
NEW YORK, NY 10017 INSURER C: Illinois National Ins Co 23817
INSURER D:
._
.
.
.--
.
.._......
._
-
INSURER E:....
COVERAGES
THE POLICIES ? OF ? INSURANCE LISTED D BELOW W HAVE BEEN ISSUED TO O THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM CONDITION 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
INSRADD'? TYPE OF INSURANCE
II POLICYNUMBER POLICYEFFECTIVE POLICY EXPIRATION LIMITS
LTR
NSR DATE(MMIDDIYYYY) DATE(MMIDD/YYYY)
A GENERAL LIABILITY
650-63-60
09!30!2009
09!30/2010 EACH OCCURRENCE 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PR
EMISES Ea occurrence
$ 1 ,000,000
- - -CLAIMS MADE
OCCUR
- MED EXP(Anyoneperson) -- - - 1,()00
PERSONAL & ADV INJURY $ 1,000
000
__ ___ ,
GENERAL AGGREGATE $ 2,000,000
GENERAL AGGREGATE LIMIT APPLIES PER
PRO- PRODUCTS - COMP/OP AG 1,000,000
POLICY JECT LOO
A AUT OMOBILE LIABILITY 664-72-65 AOS
( ) 09/30/2009 09/30/2010
COMBINED SINGLE LIMIT
$ 1
000
000
A ANY AUTO 664-72-66 (VA) 09/30/2009 09/30/2010 (Ea accident) ,
,
ALL OWNED AUTOS .... ,
n BODILY INJURY $
SCHEDULEDAUTOS
f L'
s I
r"
(Per person)
X
X HIRED AUTOS
NON-OWNED AUTOS
D L?
I
BODILY INJURY
(Per accident)
0 "1
'- PROPERTY DAMAGE
P
id
$
(
er acc
ent)
GARAGE LIABILITY F I L E ORD A.i\:L7 AUTO ONLY - EA ACCIDENT $
ANYAUTO
L Ef I
LATIVE SRVC.
DEPT
OTHERTHAN EA ACC
$
AUTO ONLY $
- AGG
EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR FI CLAIMS MADE AGGREGATE ?^ ?..... $+ ?T
$
DEDUCTIBLE
$
RETENTION S
A WORKER
EMPLOYE S COMPENSATION AND
RS' LIABILITY 428-91-48 (AOS)' 09/30/2009 09/30/2010 X WC STATU- OTH-
B 428-91-49 (AR,GA,MA,NC) 09/30/2009 09/30/2010
000
000
$ 2
ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N 91
0 .L. EACH ACCIDENT ,
,
A OFFICER/MEMBEREXCLUDED? 5
( $
0 _
FL)
42$_ 09/30/2009 09/30/2010
.L. DISEASE - EA EMPLOYE
2,000,000
C (Mandatory In NH) If yes, describe under
SPECIAL. ROVISIO S-below-- - "
- _L: DISEASE - eOLICY..LIMIT .$ .2,000,000
OTHER
C WORKER COMPENSATION 428-91-52 (OR) 09/30/2009. 09/30/2010 SEE ABOVE
B CONTINUES 428-91-53 (TX) 09/30/2009 09/30/2010
B 428-91-54 (ND,NY,OH,WA,WI,WY) 09/30/2009 09/30/2010
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER NYC-003851766-11 CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CITY OF CLEARWATER EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
FINANCE DEPARTMENT 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
ATTN: CAROL BARDEN
100 S. MYRTLE AVE. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND
CLEARWATER, FL 33756 UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
Q
AD1 MerghEB REPRESENTATNE /? ,., ?r
l
~i"?•??
Casey T.Waas
korn
ACORD 25 (2009/01) ®1998-2009 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.
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