CERTIFICATE OF INSURANCE (28)
Jun-Z9-05 14:IZ
Frcm-
T-013 P.OI/OZ F-751
............-... ...--......-- I UO/L.:::J/U::J
THIS CeRTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CER11ACATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POliCIES BELOW.
INSURERS AFFORDING COVERAGE
-,-. -jJ;l~uAe;;;ya11ey ForSe 'I.I?-s,~.!:~nce Compa~-=
INSURER8: Cincinnati Insurance
__'_. _ ,. __. on " . - _
INSUFlER c:
.-.. ILr LI c:J..&J"" '""..... I . .. . "".... I ~ "'.
PRODUCER
Hilb Rogal Hamilcon-Gville FL
4880 Newberry Road Suite 100
P.O. Box 357400
Gainesville, FL 32635-7400
-----, -.--- .--. --.
I",SURED
Jones, Edmunds & Associates, Inc.
730 NE Waldo Road
Building lIA"
Gainesyille, FL 32641
COVERAGES
INSURER 0:
INSURER E:
THE POUCliS OF INSURANCE LISTED BELOW HAve BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY peRIOD INDICATED, NOTWITHSTANDING
ANY REQUIREMENT. Te~M OFt CONDITION OF />NY CONTRACT OR OTHER DOCUMENT WITH RespecT TO WHICH THIS CERTIFICATE MAY ae ISSUI'lO OR
MAY PERTAIN, l'IiE INSURANCE AFFORDED IiY TttE POLICIES DESCRIBED HERilN IS SuBJECT TO All TI-lE TERMS, EXCI.USIONS AND CONDITIONS OF SUCH
POLICIES. AGGRIiiGATE liMITS SHOWN MAY HAVE BeEN RIiDUCEO BV PAID ClAIMS.
~ .-...-. ..--. f'Ol.ICV-EFFECTIV,~ ~LICY-EX"'iMllON- . ,- ---
TYPE op INSURANCE POLICY NUMBER OIVV DATE I..MITS
A GENERAL I..ASlllJTV C2071929190 06/30/05 06/30/06 EACH occuRRENce .. ~_J,._. 0 0 0 I 0 0 0
-X r"''''''''' "".""" ".8UN FlRIO DAM~ (~~ on!.!lfe) _ Ji.sOO.OOO
, ...J CLAIMS MAoe [X] OCCUR ~~"O/le.p.!!!~L_ .!.:J-JL 0 00
PERSONAL & ADV INJURY _ ..~1~ 0 0 ,--O~QQ...
. -----..-
GENERAL AGGREGATE $2_,--000.000
-
GE~'L A<3GREl3Ati LIMIT APnS peR; I PAOOUCTS .CQMPIOP AGG i2,_Q_QO_, QOO.
i POLICy I ~~g. LOC i
B _~TOMOBILE UAalLllY CAP5821291 06/30/05'06/30/06 COMBINeo SINGLE LIMIT $1,000,000
,X ANY AUro lEa acclcl&nt)
1..:. --...- ,--_. ,--
I-- All OWNED AUTOS IilOPILY INJURY
(perpolWO) III
SCI'iEPI,/LED AUTOS
- -----. -------.-. -. --.
~ HIAeOAl,JTOS I I BODILY INJURV
X NON.OVVNI'P AUTOS (Per accident) $
----
,-----_._'-.'----- PROPEFllY DAMA<3E $
I I (Par accidem)
~RAG;" LIAElIU'N ! ~ _~1f.I]? ONLY - EA ACCIDENT $
:._.j ANY AU1'O OTHER TJ1AN EA ACC $.
-. .. ,.. . -
I I AUTO QI\lLY: AGG S
B exCESS LIABILITY CAP5821291 106/30/05106/30/06 ~~!-,RRe~CE .l~S_,,1i OQ.,.. Q...OJL
xl OCCUR [~:J CLAIMS MADE AGGREGATe $~",_O_Q 0 ,_Q..o 0
$
~~::I oepuom~~J; -.. .
$
X RETENTION ,0 $
A WORKERS eOMPENSAllON AND WC1073646780 06/30/05 06/30/06 :x 1~~~{,:1~ I IO~-
I;MPL.OYEFiS. LlASIL.I1'Y I E.L eACH ACCloeNT sl 000 oci6
I I EL DISEASE - Ell. EMPLOYEE L. ..._,..J.__ "
I .!h...9_Q.Q..LJLQ. 9.
I I E.L DISEASE - POLICY LIMIT $1,000,000
OTHER
i
I I
I I
DESCRIPTION Of' OPERATIONSlLOCAllONSlVEHlCLESlEXCLUSIONS Al)OED BY ENDOFl$IiM&N'tI$P~jl.L PROVISIONS
Certificate Holder is named as Additional Insured m ~ @ ~ 0 ~-I
w ~
JUN29 2005 tJ
CERTIFICATE HOLDER i 1 ADDmoNALINSURED:INSlIRERLETTER: CANCEL.LATlON -. -.
City of Clearwater SHOULDANYOFTHEAElOVIiDESCA! ~~ In, ~~i,~~~~'"if1'lfEXI: RATION
DAll: THEREOF, THE ISSUING; INSUReR WILL eN~~ TO MAIL: 3.Q.::.: DAVIBYRlTTEN
Attn: Cicy Engineer NancETOTHE CERTIFICATE HOl.OERNAMeQ TOl'HlilI.IiFT. ~UTFAlLUmo TODOSOSl'lALL
PO Box 4748 IMPOSE NO 08 LIGATION OR LIABILITY OF ANY KIND UPON THS lNSlJAEA,ITS AGENTS OR
Clearwater, FL 33758 REPRESENTATIVES.
A D R~\.QESENTAllVE
~. " V - C\~
OQ -. -
ACORD 25-S (7/97)1 0 f 2
#45412
PAR Ci) ACORD CORPORA1l0N lass
......":1'-. ........... ...."'....
Cllent#: 3970
JONEEDM3
ACDBIl. CERTIFICATE OF LIABILITY INSURANCE
DATE (MMiODIYY)
06/29/05
THIS CERllRCATE IS ISSUED AS A MATTER OF INFORMA1l0N
ONLY AND CONFERS NO RIGHTS UPON THE CERllFlCATE
HOLDER. THIS CERllFlCATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
PRODUCER
Suncoast Insurance Associates
p.o. Box 22668
Tampa, FL 33622-2668
813 289-5200
INSURERS AFFORDING COVERAGE
Jones Edmunds & Associates, Inc.
730 N.E. Waldo Road
Gainesville, FL 32641
INSURER A: XL Specialty Insurance Company
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
INSURED
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLley PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR COODmoo OF ANY CONTRACT OR OTltER DOCUMENT WITH FESPECT TO WHICH llilS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, "THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEFEIN 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 NUMElER POUCV EI'l'ECT1VE ~~iJ=~~ LIMITS
LTR DATE
GENERAL LIAElILITY EAa-t OCCURRENCE $
-
COM M ERCIAL GENERAL L1ABILllY FIRE DAMAGE [f>.r>{ one fire) $
- tJ CLAIMS MADE 0 OCCUR
- MED EJ<P (Arvi one person) $
PERSONAL & foDV INJURY $
GENERAL AGGlEGo\TE $
GEN'LAGGREr9 L1M IT APnSPER: PRODUCTS - COMPIOP AGG $
I PRO-
POLICY JECTLOC
AUTOMOEllLE llAElILITY COMBINED SINGLE LIMIT
- (Ea accident) $
ANY AUTO
-
ALL OWNED AUTOS BCOILVINJURY
- $
SCHEDULED AUTOS (Per person)
-
- HIRED AUTOS BODILYINJURV
(Per accident) $
- NON-OWNED AUTOS
PROPERlY DAMAGE $
(Per accident)
GARAGE LIAEllllTY AUTO ONL V - EA ACODENT $
=i ANY AUTO OTHER THAN EA ACC $
AUTO ONL V: AGG $
EXCESS LIAElIUTV EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE . $
RETENTION $ $
WORKERS COMPENSATION AND 1,W~$I~J,~s I PJH-
ER
EMPLOYERS' liABILITY $
E. L, EAa-t ACCI DENT
E.L DISEASE - EA EMPLOYEE $
E.L. DISEASE - POlICY LIMIT $
A OTHER DPR9411907 06/30/05 06/30/06 $5,000,000 Each Claim
Professional $5,OOOPOO Ann Aggr
",lability
DESCRIPTION OF OPERATIONS/lOCATIONS/llEHICLES/EXCLUSIONS ADDED ev ENDORSEMENT/SPEClAL PROVISIONS
Professional Llablllty Is written on a claims made and reported basis.
CERTIFICATE HOLDER I I ADDmCINALINSURED;INSURERLETlER: CANCELLA1l0N
SH OULD ANYDFTH EAElOl/E DESCRIElED POLICIES ElE CANCELLED ElEFORETH E EJG>/RATlON
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAlL~DAYSWRITTEN
ATTN: Risk Management Dept. NanCETOTHE CERTIFICATE HOLDER NAMED TOTHELEFT, ElUTFAlLURE TODOSOSHALL
POBox 4748 IMPOSE NO OElLIGATION OR LIABILITVDF ANY KIND UPON THE INSURER,ITS AGENTS OR
Clearwater, FL 33758 REPRESENTATIVES.
AIITHORIZED REPRESENTATIVE
I JJ.1' ~)'\,. rxo.~ ./::;_...
ACORD 25-5 (7/97)1 of 2
#S107135/M107105
KJS
e ACORD CORPORA1l0N 1988