CERTIFICATE OF LIABILITY INSURANCE (142)ACaI2®
CERTIFICATE OF LIABILITY INSURANCE 05/14 DATE /2010
??- 05/14
2010
PRODUCER
Aon Ri sk services South, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
aon
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-(8662 283-7122 FAx- 847 953-5390 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERA! Lexington insurance Company 19437 ••
Malcolm Pirnie, Inc. TNSURFRB:
104 Corporate Park Drive L
White Plains NY 10602 USA INSURER C:
b
INSURER D: i.
a>
b
INSURER E:
COVERAGES SIR applies Der terms and conditions of the Dolicv
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 MAX
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
AT MM/DD/YYYY DATE MM/DD/
.. ERAL LIABILITY .. .
EACH OCCURRENCE
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISES (Ea
occurrence)
CLAIMS MADE ? OCCUR (An
v one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
GENL AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
? POLICY ? PRO- ? LOC
JECT
AUTOMOBILE LIABILITY
ANY AUTO
R
ECEIVED
COMBINED SINGLE LIMIT
(Ea accident)
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS ^ ( Per person)
010
25
L
HIRED AUTOS AY
BODILY INJURY
NON OWNED AUTOS (Per accident)
C D
fC
Or RECORDS
SR/CS p
?
DEPT PROPERTY DAMAGE
LEVIS nvE (Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT
H ANY AUTO
OTHER THAN EA ACC
AUTO ONLY
AGG
EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE
? OCCUR. ? CLAIMS MADE AGGREGATE
.._.-._
E
RETENTION
WC STATU- OTH-
WORKERS COMPENSATION AND I TORY LIMITS ER
EMPLOYERS' LL4BILITY
E.L. EACH ACCIDENT
ANY PROPRIETOR/ PARTNER / EXECUTIVE
OFFICERIMEMBER EXCLUDED?
(Mandator
in Nil) E.L. DISEASE-EA EMPLOYEE
y E.L. DISEASE-POLICY LIMIT
If 5, desCnlx under SPECIAL PROVISIONS below
A 015448990 06/01/2010 06/01/2011 Each 7-aim $1,000,000
OTHER prof & Poll Liab Annual Aggregate $1,000,000
Archit&Eng Prof
DESCRIPTION OF OPERA'I'IONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIA.L PROVISIONS
Re: All operations of the Named Insured. For Professional Liability coverage, the Aggregate Limit is the total
insurance available for claims presented within the policy period for all operations of the insured. The Limit
will be reduced by payments of indemnity and expense.
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
P.O. BOX 5748 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, r
Clearwater FL 33758 USA BUT FAILURE TO DO SO SHALI. IMPOSE NO OBLIGATION OR LIABILITY -
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2009/01) 01989-2009 ACORD CORPORATION. All rights reserve
The ACORD name and logo are registered marks of ACORD
-Attachment to ACORD Certificate for Malcolm Pi rnie, Inc.
The terms, 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
OTHER
J( claims-Made
1171 Professional Liabil
X? and Contractors
Pollution Liability
DESCRIPTION OF 01'ERATIONS/LOCAIIONSNERICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
cancellation Provision shown herein is sub]'ect to shorter or longer time periods depending on the
jurisdiction of, and reason for, the cancellation.
Certificate No : 570038825168