CERTIFICATE OF LIABILITY INSURANCE (137)ACOM
CERTIFICATE OF
LIABILITY INSURANCE DATE (MM/DD/YYYY)
5/5/2010
PRODUCER
WHITEHORN FINANCIAL GROUP, INC
Suite 3
44 Main Street 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.
,
Millburn, NJ 07041
(973)564-9330
INSURERS AFFORDING COVERAGE
NAIC#
INSURED Sam Schwartz Engineering, PLLC INSURER A: C. N. A.
INSURER B:
611 Suite 415,
Broadway INSURER C:
New ,
NY 10012
York INSURER D:
, INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
ANY REQUIREMENT
,
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.
INSR
LTR DVIL
INSRD
F INS LJBANCE
TYPE 0 POLICY NUMBER POLICY EFFECTIVE
DATE MM/DD/YY POLICY EXPIRATION
DATE MM/DD/YY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $
CLAIMSMADE C OCCUR MEU EXP (Any one person) $
PERSONAL&ADVINJVRY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
POLICY 71 PRO LOC
JEC7
AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT
$
ANYAUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS
(Per person)
HIRED AUTOS BODILY INJURY
$
NON-OWNEDAUTOS (Peraccident)
PROPERTY DAMAGE $
(Paraccident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANYAUTO ECEIVE OTHERTHAN EAACC $
AVTOONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
MAY 10 1a
u
I OCCUR CI CLAIMSMADE AGGREGATE $
OFFI CIAL RECORD AND
DEDUCTIBLE $
LEGI L APA SR? DEPT
RETENTION $ $
CS U- T -
WORKERS COMPENSATIONAND ORYLIMITS ER
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $
If yes,describeunder
SPECIAL PROVISIONS below E.LDISEASE -POLICY LIMIT $
OTHER
Professional AEH 11-404-42-63 09-30-09 09-30-10 $1,000,000 Per Claim
Liability $3,000,000 Per Aggregate
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
Attn : City Clerk
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Box 4748
P
O
.
. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Clearwater, FL 33758-474$
R PRESENTATIVES.
AUT 0 D REPRESENTATIVE
ACORD25(2001/08) 0ACORD CORPORATION 1988
Whitehorn Financial Group, Inc.
44 Main St, Ste 3 1528 Walnut St, Ste 6z5
Millburn NJ 07041 Philadelphia PA191o2
tel 973 564 9330 tel 215 545 8505
fax 973 564 9129 fax 215 545 85o6
W h i to h o r n PERSONAL SERVICE PROFESSIONAL SOLUTIONS
May 5, 2010
- - - -
CIty of Clearwater
Attn: City Clerk
PO Box 4748..
Clearwater, FL 33758-4748
Re: Professional Liability Insurance
CNA Policy No.: AEH 1 1-404-42-63
Insured: Sam Schwartz Engineering, PLLC
Expiration Date: September 30, 2010
Certificate of Insurance
Dear Sir/Madam:
Pursuant to the request ofour client, Sam Schwartz Engineering, PLLC, I am pleased to enclose a
Certificate of Insurance issued on the above noted policy.
Should you have any questions, please feel free to call.
Cordially,
Stephen R. Whitehorn ....
S-Qua,/,/1??a .
Enclosure .
cc: Ms. Mariessa Korhummel
Ms. Annette LeGrant
www.WhitehornFinaneial.corn