CERTIFICATE OF LIABILITY INSURANCE (3)Nipnt#- 3970
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ACORDTM CERTIFICATE OF LIABILITY INSURANCE
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DATE
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PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ISU Suncoast Insurance Assoc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 22668 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tampa, FL 33622-2668
813 289-5200 INSURERS AFFORDING COVERAGE NAIL #
INSURED INSURER A: Travelers Indemnity Company of 25682
Janes Edmunds & Associates, Inc. INSURER B: Travelers Indemnity Company 25658
730 N.E. Waldo Road INSURER C: Liberty Mutual Ins Co
Gainesville, FL 32641 INSURER D: XL Specialty Insurance Company 37885
INSURER E: Travelers Indemnity Co of Amer! 25666
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.
INSR
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
POTEC M,1DDCTIVE PIRATI
DATE M X DDJY ON
LIMITS
A GENERAL LIABILITY 951.1_902 ....
6801 06/30/2010. 06130/201-1- E.ACH.PCCURRENCE. $1000-AA9----
X COMMERCIAL GENERAL LIABILITY . DAMAGE TO RENTED PREMISE5 Ea occu $1,000,000
CLAIMS MADE Li OCCUR MED EXP (Any one person) $10,000
PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
POLICY PRO- LOC
JECT
B AUT OMOBILE LIABILITY BA1958L731 06/30/2010 06/30/2011 COMBINED SINGLE LIMIT $
X
ANY AUTO
(Ea accident) 1,000,000
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) $
X HIRED AUTOS BODILY INJURY
$
X NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE
(Per accident) $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
1 F AUTO ONLY: AGG $
B EXCESS / UMBRELLA LIABILITY CUP6513Y228 06/30/2010 06/3012011 EACH OCCURRENCE $5,000,000
7 XI O CLAIMS MADE AGGREGATE $5,090,000
DEDUCTIBLE $
X RETENTION $10,00 $
..-C
-WORKERS COMPENSATION AND __: ..:. _
WCJZ9T45M5010 _
0613012010 ... ..
06/30/2011 .. C STATU- ..._ . OTH-
-X. - ----- . _.
EMPLOYERS' LIABILITY
TOR/PARTNER/EXECUTIVE
AN
Y
PROPRIE
E-L-EACH ACCIDENT
$1,000,000
FF
CC
M
(OAAandatory In NBHR EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1,000,000
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$1,000,000
D OTHER Professional
Liability DPR9685880 06/30/2010 06/30/2011 $5,000,000 per claim
$5,000,000 annl aggr.
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Professional Liability is written on a claims made and reported basis.
Project: 2009 Engineer of Record
City of Clearwater is listed as additional Insured with respect to the General and Auto Liability policies.
City of Clearwater
Attn: City Clerk
PO Box 4748
Clearwater, FL 33758-4748
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 4_ 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.
j BRED REPRESEjI7AlIVE
oi ,
ACORD 25 (2009/01) 1 of 2 #S258049/M257967 Q 1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD MRL
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 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 (2009/01) 2 of 2 #S258049/M257967