CERTIFICATE OF LIABILITY INSURANCE (130)L6Len2,`,: tU44bb LL'La1L7LuKA1
DATE (MWDDNYYY)
C ?'A _ _L 10129109
PRODUCER THIS C ...r!CATE IS ISSjFD AS A MATTER OF IiN;F0RMA,T ON
t/SI Ins. Services of CT, Inc. ONLY AND CONFERS NO R G.HT5 UPON THE CER7?FICATE
530 Preston Avenue HOLDER. THIS CERTIFICATE DOFS NOTAMEND, EXTEND OR
ALTER THE COVERAGE .AF=CRDE'D BY TH7 POLICIES BELWff.
WQrtden, CT 05450
203 634-5700
INSURED
Leggette Brashears Graham Inc.
4 Research Drive, Ste 301
Shelton, CT 06484
INSURERS AFFORDING COVERAGE NAIC P-
INSUf;EFtA Hartford Fire Insurance Co 19682
INSURE[ I F Hartford Casualty Insurance Company 79424
sUFFP Hartford Accident & Indemnity Compan 22357
American International Specialty Lin 26883
Ih:?UI?E. E
COVERAG-S
THE AU,LI?IET OF I^JSUR.AIVuE 1151 ELI BL?u'tF. lhAb'E FLAN ISSUED 10 IIiE NICRL[7 P,ACSEU, .,BL,'E FOR THE PGL,CY ?'ERIn7) IfygICATEC3.IVC3TI°t1!rI+',P.[7lliG
ANY REQI fIREhAENT TERM 0RCONDJ7R-N OFANY CCNTR+,-T OR CITHER, C._I.,U%ENT', WITH RESP ECT TC .VH1r-H THIS c,Hp ,., ILATE MAY BE ISSUEE OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE F 1.11LI ,ES DEFCRISED HEREIN IB SI,B.,E":T TC` ALL Ii IL 1 EPNIS, LXCLUSIONS AND CONDITIONS OF SUCH
PCLICIL A5l3RLGAIL _IMITS SHUZ.A %1AY LAVL'6LEN RLLUEEL) by 'P'AID C'LAAIS
IN R SPR TYPE OF INSURANCE POLICY NUMBER DATE 'F0.' iDFJY)
LYR ryS
_ ATEMi?D.I'fY m; -DATE-LAM-DDfYYON
_DATE h7
LIMITS
A GENERAL LIABILITY 31 UNZK62.56 11101109 11101110 EACH I T' '-'-PENCE f1 00o GqO
X COMMEF :iAL(3ENEIRALUABILITY CAI I Ir I O F; ! "-D
N f1 1 CCCI CI C
?lIAF3 M#D ER OCCUR TALE Y F 'And . F ?sen} ;r'? C, C,
X Ccnfraclual PERK )h lU4?'.f s IF?C, IC ,Wt
X k,C,U induded GENERA_A&= E 'J $3 000 000
rLE.N°LAC`Gk'-GATELIMI'•A.PPLIE$PER: PRODUCTS-C II,I'i0.'AGG $310001000
_ JEUT LOC
B AUT OMOBILE LIABILITY 31 UEN K6068 11/01109 11/01/10 CC>AdPINLH) SINGLE LIMIT
(Ea €??nt) $1,1}OO,Of}0
ANY AUTO
ALLOWNEDAIJTOS 'INJ Y
$
ECF"EDULED AUTOS
HII'F.D AuTos SOD'! Y INAPPY
n
NON-OWNED AUTOS
rear 1[_I_I_iwn[:y S
PIRiL IF OrY DAMAGE
-
(per ('PFU awde?nt)
GARAGE LIABILITY AUTO ONLY - E Af ..D-?T $
ANYAUTO THAN - - '
OTHER $
.
AUTC:ONLY AGG $
B EXC ESSI'UMBRELLA LIABILITY 31 HUF.07 26 11101108 11101111 E' y ? IJF:RENCE $10,000,000
OCCUR CLAIMS MADE r,? E: aYE $10,000.000
$
LDi IC, ILaLE $
10,000 $
C WORKERS COMPFNSATIONA!4D 31WENJO522 11/011109 1i1Q1110 X U- ]TH-
wO I
••
EMPLOYERS' L ABILITY
FIROPP F-7 F+
FTNFh
;i?CUTIVE
ANY
E.L E -I .,?':r IF.FPJT f
$1,?} a,aaa
'.
;.
?.
OFFIDEkrInEII,E E.L DISEASE-EA EMPLOYEE $1,000,000..
SPFUHI PPT;'I fIL-00,W
- :E.L DISEASE - OOUCYLIMIT $1,000,000
D OTHER ?olla?tirrL1 COP53778313 06119109 06117111 $5,000,000/$5,000,000
Professional I_iab Deductible. $50,000.
Claims Made Coral
DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
***Supplemental Names**"
Leg2etia Brashears & Graham Inc.
LBG Enc neering Services, PC.
Leggetie Brashears &. Grah,arn, Inc. ba LBG.Guyton Associates
(See Attached Descriptions)
City of Clearwater
Attn. City Clerk
P.C. Box 4748
CLEARWATER, FL 337 84.748
HOUt 13 ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
ATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR. TO MAIL 30 DAYS WRITTEN
OTICE TO THE CERTIFICATE HOLDDER. NAMED TO THE LEFT, BUT FAILURE TO pO SO SHALL. ''...
'POSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
EPRI-SENTATIVES.
,07 HORIZED REPRESENTATIVE
-47, :1
ACCORD 2 (2001108) 1 of 3 #M4099655
SAA H Q ACCORD CORPORATION 1988
-1-;JT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) roust be endorsed. A statement
on this certifkate 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 polio, 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).
DISC _AHVi E R
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 25-S (2401108) 2 of 3 #M4099655
DESCRIPTIONS (Con nu from Page 1
30 Days Notice of Cancellation except 10 Days for Nan Payment of Premium
City of Clearwater is named as Additional Insured with respects to the
above General Lability and Automobile policies.
ASS 25.3 (2001108) 3 of 3 M4099655