CERTIFICATE OF INSURANCE (19)
Jun-30-04 07:19 From-
~1LIL1'1.1Jr~ ul:.n I Irlu"" I I;, ur
PROOUQEA
Hilb Rogal Hamilton-Gville FL
4880 Newberry Road Suite 100
P.O. Box 357400
Gainesville, FL 32635-7400
T-4Z4 p,o 101 F'131
LIMUILI I I 1I.~UnJ-\I~\.Ia:: ( 6/29/04
THIS CERTIFICATE 'IS ISSUED AS A MATI 5RC :- i jf; )RMATlON
ONLY AND CONFERS NO RIGHTS up, 'II Tt: ::E FtTIFICATE
HOLDER. THIS CERTIFICATE DOES NO' AMI 1111 E O"END OR
ALTER THE COVERAGE AFFORDED BY HE J ?!! ~Il S BELOW.
INSURERS AFFORDING CO 'ERA E
INSURED
Jones, Edmunds & Associates, Inc.
730 NE Waldo Road
Building "A"
Gainesville, FL 32641
COVERAGES
THE POLICIES OF INSURANCE. 1..ISTEO BELOW HAve BEEN ISSUED TO THe INSURED NAMED ABOVE FOR THE POLICY PERIOD IND :;ATEI ~ ( 'T'i /ITHSTANOING
ANY Rt:;QUIREMENT, TERM OA CONDITION OF' /lJ\lY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS OEFlTIICATI M ~ ( I e: ISSUED OR
I MAY PERTAIN, THE INSURANCE AFFORDED BY THe POUCIES DESCRIBED HERBN IS SUBJECT TO AU. THe TeRMS. aCLUSION ; AND :0,)11 ONS OF SUCH
POliCIES. AGGREGATE LIMITS Sfo!OWN MAY HAVE 8EEN REDUCED BY PAlO ct..A1MS.
'rMTYPIi! OF INSURANCE POUCV NU";~R '"gItCY EFFECTIVE POlICY E)('piAA)]ON LlM 9"" ,-
!A GeNeRAL-LIABILITY C2071929190 06/30/0406/30/05 EACHOCClJRRENC!- 5:'::::)00.000
I X eOMMfFlCIALGENEI\ALLIABIUTY F~~AGE(~, 1&lil$) 5i:Q. ~O
I CLAIMS MADE [K] OCCUR MED EXP ~.p. ~~ ~ ; .Q, 0 0 0
PERSONAL. 8. AOVIl' J~!!_ (.L) 0 0 , 0 0 0
GENERAL AGGReGi E_ .~;.L) 0 0 , 000
PRODUCTS .COMP, If> AGe $; .~. ) 0 0 , 000
INSURI!JilA: Valle"--FO};~ge Insura: Lee ~; ~ Jany
INSUREFlI!l: Cincinnati Insuranc,:
-- - - -- ---............
INSURER c;
INSUfUOR D;
INSURER E:
GI5N'1.. AGGREGATE LIMIT APPLIES PEA:
- POLICY PRO. LOC
B AUTOMQBlLE UAalLITV
X ANV AUTO
ALL OWNIOO AUTOS
SCHIiDUlEO AUTOS
X Hll'\EO AU'I'OS
,X NON-QWNliP AUTOS
CAP5821291
06/30/04 06/30/05
:i.~~~t~INGLe, _""1'1'_. ~::. '.__' ) 0 0 , 000
filODIL V INJURV .
(Per person)
BOPII.. Y INJURY
(Por llQoidonf)
$
PROPERTY DAMAG'
(PM accld8l\l)
$
GARAGE; LlABIUTY
ANY AUTO
CAP5821291
06/30/04 06/30/05
AUTO 0\Il1.. V .1''' AC, ICENT ..!.._
OTHIOR THAN ' 'I ACC ..! _ '_ __
AUTOONL.Y; -2 ..!._
EACH OCCURRSNCE .!; .1_ lQ 0 , 0 0 0
.o\GGAEGATE .!; .,_ ULO , 0 0 0
.1 ___
.1..---
.!. .-
DEDUCTIBLE
X ReTENTION $0
A WOFlKa:lS COMPENSATION AND
EMPL.OVeRS' UABIUTY
WC1073646780
06/30/04 06/30/05
,O'l'f;
-us
&,L. EACH ACCIDENT ..!! .L ) 0 0 I 0 0 0
E.L,DISEASE-EAt:;~ ~~~ .1! LlOD, 000
E.L- OISEASr;; . POL.I( ~I.IMI1 1.!.L) 0 0 000
OTHeR
CERTIFICATE HOLDER
ADOITlONALINSURI;D;INSUREI'l Ll!.TTEI'l;
CANCELLATION
. ii;-r-'-
~ s n
~' i
I'l
JUN 3 0 [,,:,~LU)
CITY OF CLfARW!\ I ~ P
, .,,_..,....,. ~N-',
C~CRIPl1DN OF OPIlRATIONSlLOCATIONSlVEHICLESlEXCLUSJONS ADDED BY I!NPOASEMENTIS~AL PIlOVISIONS
Certificate Holder is named as Additional Insured
City of Clearwater
Attn: City Engineer
PO Box 4748
Clearwater, FL 33758
SHOULOANYOFTIfEABOVI;DIOSCRIBEDPOLlClESBECANOI .LIODE FC'll;lIEElCRRATlClf\I
OATIS THERIlOF, THE ISSUINClINSUFlER WILL 1l"'~VOA OMAh. 1..1._ IAYSWRJTTeN
NOT1CSTOlllE CelmFICATE HOLDER"AMIlP TOTH! LEF'l'. IlJTFA Uti TC OOSOS"Al..L
tMPOSE NOOElLIQAl1ON OtH.IAfllI.ITYOFANYKlNO UPON HEIN JH 'l,1' SAGENl50R
ASPRESENTAl1VE8.
AU HORIZED REPRESE".TATlVE
ACORD 25-$ (7/97) 1 of 2
#S38685/M38672
--"'-
PAR @ A( ORO ;Of PC RATION 1988
C Iient#: 3970
JONEEDM3
ACDBD. CERTIFICATE OF LIABILITY INSURANCE
DATE (MM,oDIYY)
06/30/04
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
Suncoast Insurance Associates
P.O. Box 22668
Tampa, FL 33622-2668
813289-5200
INSURERS AFFORDING COVERAGE
Jones Edmunds & Associates, Inc.
730 N.E. Waldo Road
Gainesville, FL 32641
INSURER A: XL Specialty
INSURER B:
INSURER C:
INSURER D:
INSURED
INSURER E:
COVERAG ES
:[
[
I
1
;
,
j
~
i
I
~I
"
~
1
J
"
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO -mE INSURED NAMED ABOVE FORlHE POLICY PERIOD INDICATED. N01WI-mSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR O-mER DOCUMENT WI-m RESPECT TO WHICH lHlS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN. -mE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL -mE TERMS, EXCLUSIONS AND CONDmONS OF SUCH
POLICIES. AGGREGATE L1M ITS SHOWN MAY HAVE BEEN REDUCED BY PAID a..AIMS.
NSR POLICY NUMBER POLICY EFFECTIVE ~~.fJ~~~~N
LTR TYPE OF INSURAN CE DATE LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
-
COM M ERCIAL GENERAL LIAS ILlTY FI RE DMAAGE (Any on<> fir.) $
- =.J CLAIMS MADE D OCCUR
MED EXP (Anyone porson) $
-
PERSONAL & ADV INJURY $
-
GENERAL AGGREGATE $
GEN'L AGGREGATE LI M IT APPLIES PER: PRODUCTS .COMP/OPAGG $
I n PRO- nLOC
POLICY JECT
AlITOMOBILE LIABILITY COMBI NED SINGLE LIMIT
- (Ea accident) $
- ANY AUTO
ALL OWNED AUTOS BOOIL Y INJURY
- (Per person) $
SCHEDULED AUTOS
-
HI RED AUTOS BOOIL Y INJURY
- (Par accidfml) $
NON.OWNED AUTOS
-
- PROPERTY DAMAGE $
(Per aoddonl)
==fAGE LIABILITY AUTO ONLY. EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
:=J OCCUR D CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
~'6%$T~JI~" I IOTH-
WORKERS COMPENSATION AND ER
EMPLOYERS' LIABILITY $
E.L. EACH ACQDENT
E.L. 01 SEASE. EA EMPL OYEE $
E.L. DISEASE. POLICY LIMIT $
A OTHER DPR9403nO 06/30/04 06/30/05 $3,000,000 ea claim
Professional $5,000,000 ann agg
lability
DESCRIPTION OF OPERATIONS/LOCATIONSjVEHICLES/EXClUSlONS ADDED BY ENDORSEMENT/SPEOAL PROVISIONS
Professional liability Is written on a claims made basis.
CERTIFICATE HOLDER I I AD 0 mONAL INSURED:INSURER LETTER: CANCELLATION
SH OULD ANYa' TH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAlL~DAYSWRITTEN
A TIN: City Engineer NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTHELEFT. BUT FA/LURE TODOSOSHALL
POBox 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANYKlND UPON THE INSURER,ITS AGENTS OR
Clearwater, FL 33758 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
I 1)/,{)..1 h.... cx.a1(~.~L.~....
ACORD 25-S (7[97}1
012
#59044 O/M904 33
MLI
@ ACORD CORPORATION 1988
1
I
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.
I
1
,
I
I
I
!
I
I
!I
t
ACORD25-S(7/97)2 of 2 #S90440/M90433
Client#: 3970
JONEEDM3
ACDBD. CERTIFICATE OF LIABILITY INSURANCE
DATE (MMJODIYY)
06/30/04
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PROOUCER
Suncoast Insurance Associates
P.O. Box 22668
Tampa, FL 33622.2668
813289-5200
INSURERS AFFORDING COVERAGE
Jones Edmunds & Associates, Inc.
730 N.E. Waldo Road
Gainesville, FL 32641
INSURER A: XL .l5Recialty__
INSURER B:
INSURER C:
INSURER D:
INSURER E:
INSURED
COVERAGES
j
I
i
l
.
I
i
1
j
,
!
I
I
I
i
!
I
t
i
l
I
.
1
i
l
I
t
I
I
.l
1
I'
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO lllE INSURED NAMED ABOVE FOR "THE POLICY PERIOD INDICATED. NOlWlll-ISTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WIlli 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 a..AIMS.
NSR TYPE OF INSURANCE POLICY NUMBER "gk~Cti E.r~~ f~i~ i.,x:~reN
LTR LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
~
COM M ERCIAL GENERAL LIABILITY FI RE DAMAGE (Any ene flr9) $
- =.J CLAIMS MADE D OCCUR
- MED EXP (Anyone persen) $
- PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS .COMP/OP AGG $
II nPRO- nl
POLICY JECT LOC
AUTOMOBILE L1AB1UTY COMBINED SINGLE LIMIT
r-- $
~Y AUTD (Ea accidool)
f.-
ALL OWNED AUTOS BODILY INJURY
r-- $
SCHEDULED AUTOS (Per person)
r--
HI RED AUTOS BODILY INJURY
r-- (pQr accidQllI) $
NON.OWNED AUTOS
r--
r-- PROPERTY DAMAGE $
(Per accidenl)
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
R ~Y AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
5ESS LIABILITY EACH OCCURRENCE $
OCCUR D CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND ~~~$I~~I~s I IOJ~'
EMPLOYERS' UABILITY
E.l. EACH ACCI DENT $
E.L. DI SEASE. EA EMPL OYEE $
E.L. DISEASE. POLICY LIMIT $
A OTHER DPR9403770 06/30f04 06f30fOS $3,000,000 ea claim
:lrofessional $5,000,000 ann agg
ia bllitv
OESCRIPTION OF OPERATIONSjLOCATlONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Professional Liability Is written on a claims made basis.
CERTIFICATE HOLDER I IIlDDIT10NAL INSURED;INSURER LETTER; CANCELLATION
SH OULD ANYOFTH EAElOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O.....-DA'VS WRITTEN
ATTN: City Engineer NOTICETOTHE CERTIFICATE HOLDER NAM ED TOTHE LEFT, BUT FAILURE TODOSOSHALL
POBox 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANYKlND UPON THE INSURER,ITS AGENTS OR
Clearwater, FL 33758 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
I Af)y n... ~~.a--..~
ACORD 25-S (7}97)1
of 2
#S90440/M90433
MLI
(;) ACORD CORPORATION 1988
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.
ACORD2S-S(7,'97l2 of 2 #S90440/M90433