CERTIFICATE OF LIABILITY INSURANCE (116)DATE (MMIDDIYYYY)
ACOREL CERTIFICATE OF LIABILITY INSURANCE 10 19 2009
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
WHITEHORN FINANCIAL GROUP, INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
44 Main Street Suite 3 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Millburn, NJ 07041
(973)564-9330
INSURED Sam Schwartz Engineering, PLLC
INSURERS AFFORDING COVERAGE
NAIC#
611 Broadway, Suite 415
New York, NY 10012
CnVFROC,FS
INSURER A: C. N. A.
INSURER B:
INSURER C:
INSURER D:
INSURER E
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVATHSTANDING
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 LIMITSSHOWN MAY HAVE BEEN REDUCED BY PAIDCLAWS.
INSR
1, BDL
NSRD : P F INSURANCE POLICY NUMBER POLICY EFFECTIVE
DATE MMIpD/YY POL MXWFIRATION
DATE MIDDIYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY EIF
PREMISES Ea occurence $
CLAIMSMADE C OCCUR ME? EXP (Anyone person] $
PERSONAL& ADV INJURY $
GENERAL AGGREGATE $
FGEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $
I PRO
I
LOG
POLICY
JECT
AUT OMOBILE LIABILITY COMBINED SINGLE LIMFF S
ANYAUTO {Ea accident}
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Perperson) I $
HIRED AUTOS I
BQDILYINJURY
NON-OWNED AUTOS $
[Peraccident]
PROPERTY DAMAGE
$
[Peraccident]
GARAGE LIABILITY AUTO ONLY -EAACCIDENT S
ANYAUTO OTHERTHAN EA ACC $
AUTOONLY: AGG . S
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR CI CLAIMSMADE AGGREGATE $
$
DEDUCTIBLE $
R RETENTION $ S
WORKERS COMPENSATION AND TORYLJMITS ER
EMPLOYERS' LIABILITY
PROPRIETORIPARTNERIEXECLFrlVE
E. L. EACH ACCIDENT $
ANY
OFFICEIVMEMSER EXCLLloeo? E. L. DISEASE - EA EMPLOYE $
Ayes, describe under
SPECIAL PROVISIONS below E. L. DISEASE - POLICY LIMIT $
OTHER
Professional AEH 11-404-42-63 09-30-09 09-30-10 $1,000,000 Per Claim
Liability $3,000,000 Per Aggregate
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLE5I EXCLUSIONS ADDED 6Y ENDORSEMENT/ SPECIAL PROV151UN5
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO MAIL30 DAYS WRITTEN
Attn : City Clerk NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHA1,L
P.O. Box 4748
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Clearwater, FL 33758-4748
REPRESENTATIVES.
T IIE? REPRESENTATIVE
ACORD 25 [2001!08] m ACORD CORPORATION 1988