CERTIFICATE OF LIABILITY INSURANCE (123)Ate- DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 12/18/2009
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
Aon Risk Services south, Inc.
Franklin TN Office AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
501 Corporate Centre Drive CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
Suite 300 COVERAGE AFFORDED BY THE POLICIES BELOW.
Franklin TN 37067 USA
PHONE-(866) 283-7122 PAx- 847 953-5390 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A! Greenwich insurance Company 22322 ••
Malcolm Pirnie, Inc. ~
INSURER B: XL Specialty insurance Co 37885 w
104 Corporate Park Drive
white Plains NY 10602 USA INSURER C: v
INSURER D: F,
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INSURER E: O
COVERAGES SIR applies per terms and conditions of the policy m
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 INS TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
ATE MM/DD/YYYY DATE. MM/DD/YYYY
A kWERAL LIABE.ITY GE0001076108 01/01/2010 01/01/2011 EACH OCCURRENCE $1,000,000
X
General Liability
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $1,000,000
- PREMISES (Ea occurrence)
CLAIMS MADE ® OCCUR D FXP (Any one personT $10,000
PERSONAL & ADV INJURY $1,000,000
F1 GENERAL AGGREGATE s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS -COMP/OP AGG
$2,000,000
? POLICY E PRO- LOC
IECT
B AUTOMOBILE LIABE.rrY AE0001075808 01/01/2010 01/01/2011 COMBINED SINGLE LIMIT
X ANY AUTO Auto (AOS) F"
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P t
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d r ?`?
L
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Il (Ea accident) S1,000,000
ALL OWNED AUTOS .-
?
7?. n w.
, BODILY INJURY
SCHEDULED AUTOS t h
O 4 2 1
10 (Per person)
)( HIRED AUTOS ? A
`I- BODILY INJURY
X NON OWNED AUTOS (Per accident)
OF ICIAL RECOR DS AND
PROPERTY DAMAGE
LE EPT P
id
G ISLATIVE SRS S D ent)
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GARAGE LIABILITY AUTO ONLY - EA ACCIDENT
R ANY AUTO
OTHER THAN EA ACC
AUTO ONLY:
AGO
A EXCESS / UMBRELLA LIABILITY UECO01075908
b
ll 01/01/2010 01/01/2011 EACH OCCURRENCE
El OCCUR ? CLAIMS MADE um
re
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AGGREGATE
$10,000,000
: 0- __. DEDUCTIBLE
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RETENTION
B RWD943528401 1 X C STATU- OTH-
WORKERS COMPENSATION AND workers compensation I TORY LIMITS ER
EMPLOYERS'LIABE.TFY YIN E.L. EACH ACCIDENT $1, 000 , 000
ANY PROPRIETOR /PARTNER /EXECUTIVE
OFFICER/MEMBEREXCLUDED?
Mand
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in NH
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E.L. DISEASE-EA EMPLOYEE
$1,000,000
(
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a
o E,L, DISEASE-POLICY LIMIT $1,000,000
If es, describe under SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEMCLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Re: All Operations of the Named Insured. If required by written agreement, the Certificate Holder is included as
additional insured as it pertains to the work or services performed for the certificate holder (except for wC)
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CERTIFICATE HOLDER CANCELLATION
city of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ExPIRATION
Attn : City clerk DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
PO Box 5748 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Clearwater FL 3 3758 USA BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHOR IZED REPRESENTATIVE
lqe.
ACORD 25 (2009/01) 01988-2009 ACORD CORPORATION. All rights reserve
The ACORD name and logo are registered marks of ACORD
Attachment to ACORD Certificate for Malcolm Pirnie, Inc.
The terns, 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
Malcolm Pirnie, Inc.
104 Corporate Park Drive
white Plains NY 10602 USA
INSURER
INSURER
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/VEIRCLES/EXCLUSIONS ADDED BY ENDORSEMIENT/SPECIAL. PROVISIONS
the policies of the insured will provide for contractual Liability, waiver of Subrogation, or separation
of Insureds/Severability of Interests. if required by written agreement, the we/EL, General, Auto &
Umbrella/Excess liability policies of the Insured will be primary and non--contributory with any other
insurance as it pertains to the work or services performed for the certificate holder. The "xcu"
exclusion has been removed for General Liability insurance. Cancellation provision shown herein may be
subject to shorter or longer time periods depending on the jurisdiction of, and reason for, the
Certificate No : 570037113805