CERTIFICATE OF LIABILITY INSURANCE (120)OP ID ET
ACDRD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYI'1?
BAKEBAR 11/11/09
PRODUCER 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
Box 4927
P
O 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
Inc
rrios Architects
B
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B INSURER C: _
,
.
a
er
a
189 S. Orange Avenue,Ste #1700 INSURER D
Orlando FL 32801
INSURER P.
rnvconr_ec
.` 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.
LTR I NSR TYPE OF INSURANCE T POLICY NUMBER DATE (MM/DD/YY EFFECTIVE PDATE MMIIDD/YY N LIMITS
GENERAL LIABILITY EACH OCCURRENCE $_1000000
A
X
COMMERCIAL GENERAL LIABILITY
Z 15BA UF62 97
11/15/09
11/15/10 '
PREMISES (Ea occurence)
$1000000
CLAIMS MADE OCCUR MEP EXP (Any one person) $10000
- PERSONAL &ADVINJURY ? $ 100000_0
^
GENERAL AGGREGATE $ 2000000
^^
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOPAGG $2000000
POLICY JEFO X LOC
AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT
$
(Ea accident)
ANY AUTO
ALL OWNED AUTOS BODILY INJURY
$
(Per person)
SCHEDULED AUTOS
-- HIRED AUTOS BODILY INJURY
$
(Per accident)
NON-OWNED AUTOS
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $ W _.._
H AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5000000
A X OCCUR F-ICLAIMSMADE 21SBA UF6297 11/15/09 11/15/10 AGGREGATE $ 5000000
DEDUCTIBLE $
X RETENTION $ 10000 $
WORKERS COMPENSATION AND X TORY LIMITS ER
B EMPLOYERS' LIABILITY
TIVE
WC0253005502
09/01/09
09/01/10
E.L. EACH ACCIDENT
$500000
- - ANY PROPRIETOR/PARTNER/EXECU
e
XCCUDED?--`-'- ---
6FWCER/ME ==' --- E.L. DISEASE - EA EMPLOYEE $5
00000
und
r
S
yes , describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$ SOOOOO
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
C'FRTIFIrATF HOI 17FR 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 0 BOX 4758 REPRESENTATIVES.
Clearwater FL 33758 IZE REPRESENTATIVE
ACORD 25 (2001/08) UAGORD CORPORATION 1958
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 (2001108)