CERTIFICATE OF LIABILITY INSURANCE (121)AC p DATE(MM/DD/YYYY)
?- CERTIFICATE OF LIABILITY INSURANCE F
11/25/2009
PRODUCER r
j Aon on 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
Portland OR 97204-1309 USA .
1.4
PHONE-(503) 224-9700 FAx- 503 295-0923 INSURERS AFFORDING COVERAGE NAIC # rH
INSURED INSURER A: American Economy Ins Co 19690
TBE Group, Inc. Cardno TBE
380 PARK PLACE BLVD., SUITE 300 INSURER 6: American States Ins Co 19704 t;
CLEARWATER FL 33579 USA INSURER C: Charter oak Fire Ins CO 25615 d
b
INSURER D: Travelers Property Cas Co of America 25674 t~.,
d
INSURER E: Great American Insurance CO. 16691 p
COVERAGES STR annl i ac nar tarmc anrT rnneii ri nnc of thn nnl i rv x
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 INSRII TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
ATE M/DD/YY DATE M/DD
D RAL LIABILITY 6801893L12009 09/30/2009 09/30/2010 EACH OCCURRENCE $1
000
000
(AOS)
GL ,
,
D X COMMERCIAL GENERAL LIABILITY 68019121-57A09 09/30/2009 09/30/2010 DAMAGE TO RENTED $1,000,000
CLAIMS MADE ® OCCUR
GL (CA) PREMISES MISES (Ea nccurrrnce)
C
68022481
72A09
09/30/2009 MED.EXP Any one pcreon)
X No deductible - 09/30/2010
GL (FL) pgRSgNAL& ADV INJURY
$1
000
000
,
,
D
GENL AGGREGATE LIMIT APPLIES PER PACP1920L96209
GL (TX) 09/30/2009 09/30/2010 GENERAL AGGREGATE $2,000,000
:
? POLICY ® PRO- ?
LOC
PRODUCTS -COMP/OP AGG
Included
IECT
A AUTOMOBILE LIABILITY 02-CE-213172-10 09/30/2009 09/30/2010
X ANY AUTO
Auto (AOS) COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
A 02-CE-213191-10 09/30/2009 09/30/2010
ALL OWNED AUTOS Auto (VA)
B
SCHEDULED AUTOS
01-CI-285296-10
09/30/2009
09/30/2010 BODILY INJURY
(Perpenon)
Auto (N])
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
ECEM
®/30/2010
: (Per accident)
X $1,000 Comp/Coll Ded Auto (GA) PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT
ANY AUTO OFFI w?
I4 RECORD /?
AND
H OTHER THAN EA ACC
LEGIS LATIVE SRVC DEPT AUTO ONLY.
AGG
E EXCESS/UMBRELLA LIABILITY T000016410-00 09/30/2009 2010 EACH OCCURRENCE ,
OCCUR ? CLAIMS MADE AGGREGATE $1510001000
DEDUCTIBLE
E _
db0 v~_
,.;._-...r ..._..
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?-
. ??K.:._ . ..
_ . -... -. _...
RETENTION ,
F WORKERS COMPENSATIONAND 5bFELR1509 09/30/2009 0973072010 X WC STATU- OTH-
EMPLOYERS' LIABILITY Y
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1,000,000:
OFFICER/MEMIAEREXCLUDED)
(Mandatory in NH) E.L. DISEASE-EA EMPLOYEE $1,000,000
If yes, descn'be under SPECIAL PROVISIONS below E.L. DISEASE-POLICY LIMIT $1,000,000
G
OTHER
013001507
11/26/2009
1
Each Claim $5,000,000
Archit&Eng Prof
Aggregate $5,000,000
SIR $250,000
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
1.A1lI1.1?,LLA 11V1N1
city of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION I
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 NOOBLIGATIONORLIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE , Q4.
ACORD 25 (2009/01) 01988-2009 ACORD CORPORATION. All rights reserved^
The ACORD name and logo are registered marks of ACORD M
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 F Hartford Casualty Insurance Co 29424
INSURER G Lexington Insurance company 19437
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 ENDORSEMENTISPECIAL PROVISIONS
certificate holder.
Certificate No : 570036920903