CERTIFICATE OF LIABILITY INSURANCE (17)rRimnf#• RA252
1GLOBSPE
ACORD- CERTIFICATE OF LIABILITY INSURANCE
DATE
/29/10D"""Y'
03
PRODUCER
Willis of Pennsylvania, Inc.
100 Matsonford Road 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.
Bldg. 5, Suite 200
Radnor, PA 19087
INSURERS AFFORDING COVERAGE
NAIC #
INSURED INSURER A: Nautilus Insurance Co. 17370
Global Spectrum, LP INSURER B: Great Divide Insurance Company 25224
3601 S. Broad Street INSURER c: Gemini Insurance Company 10833
Philadelphia, PA 19148 INSURER D: Philadelphia Insurance Co 23850
INSURER E:
COVERAGES
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
NSR
TYPE OF INSURANCE
POLICY NUMBER POLICY EFFECTIVE
DATE POLICY EXPIRATION
DATE MM/DD/YY
LIMITS
GENERAL LIABILITY EACH OCCURRENCE_
COMMERCIAL GENERAL LIABILITY DPREMISES 117a occurre 'I AMAGE TO RENTED $
CLAIMS MADE LJOCCUR MED EXP (Any one parson) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
D JET LOG
POLICY
D AUT OMOBILE LIABILITY PHPK484383 DO -tlytL) 10/18/10 COMBINED SINGLE LIMIT
X ANY AUTO
T %W
accident)
$1,000,000
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS
A
0 2 2010
(Per person)
$
HIRED AUTOS D RY
BODILY
NON-OWNED AUTOS
IC
FF
O ?p
RE??/+.VI?pS
ccident)
(Per
$
?
+
LRAS $RVCS p r' PROPERTY DAMAGE
(Per accident) $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
1 CLAIMS MADE
OCCUR F AGGREGATE $
-
DEDUCTIBLE $
RETENTION $
-
-
- $
061
1
? 03/30/1
0 !3O!=I'! WC STATU- F
H-
To
T
_A-_.
B WORKER,G.-CL?MI?FNSAT7ON.AND_ .____
EMPLOYERS' LIABILITY .
.
-?
)
WCA103669411 (AOS) -
.
-... -
03/30/10 --..
03/30/11 E.L. EACH ACCIDENT $1,000,000
ANY PROPRIETOR/PARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED?
E.L. DISEASE - EA EMPLOYEE
$1,000,000
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$1,000,000
C OTHER Professional
Liability VPPL003461 04/01/10 04101/11 $2,000,000 Limit
$5,000 Deductible
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
RE: Harborview Center, 300 Cleveland Street, Clearwater, FL 33755
City of Clearwater is included as Additional Insured solely with respect
to the operations of the Named Insured for Auto Liability as required by
signed contract.
City of Clearwater
112 S. Osceola Avenue
Clearwater, FL 34618
liAry6r GLLA I 1 V R
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001/08) 1 of 2 #M486252 UVAN 0 ACORD CORPORATION 1986
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 25S (2001/08) 2 of 2 #M486252