CERTIFICATE OF LIABILITY INSURANCE (143)Client#: 2962
SDIENVI3
ACOR
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY)
UM
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ISU Suncoast Insurance Assoc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P
O
Box 22668 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
.
. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tampa, FL 33622.2668
813 289.5200 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURERA: American Safety Indemnity Compa 25433
SDI Environmental Services, Inc. INSURER B: Travelers Indemnity Company 25658
3903 Premier North Drive INSURER c: Travelers Casualty and Surety C 19038
Tampa, FL 33618 INSURER D: Travelers Indemnity Co of Amer! 25666
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 g TYPE OF INSURANCE POLICY NUMBER D C(yMNMRMIVE POLIGY DD ENYM XPIRATION LIMITS
A GENERAL LIABILITY ENV0106240905 09102/2009 0910212010 EACH OCCURRENCE $1.000.000
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
irrence) $50,000
N CLAIMS MADE :OCCUR - - - MED F?XP (Any one parson) $5 X60
PERSONAL & ADV INJURY $1,000.000
GENERAL AGGREGATE s2.000.000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $1,000,000
POLICY PRp LOG
D AUT OMOBILE LIABILITY BA25621_14409 07/29/2009 07/29/2010 COMBINED SINGLE LIMIT
X ANY AUTO (Ea accident) $1,000,000
ALL OWNED AUTOS
B
SCHEDULED AUTOS R ECEIVE ODILY perso INJURY $
X HIRED AUTOS
X
NON-OWNED AUTOS BODILY INJURY
(Per accident) $
L - 7 2010
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY r C
y?y`y
?+ '
dd AUTO ONLY-EA ACCIDENT $
ANY AUTO LEGISL y
F
?
?Y C
ATIVE S1. EF
F1 EA ACC
OTHER THAN $
AUTO ONLY: AGG $
B EXCESS / UMBRELLA LIABILITY CUP6416Y164 06/30/2010 06130/2011 EACH OCCURRENCE $1.000
000
X OCCUR ? CLAIMS MADE AGGREGATE ,
$1,000,000
$
DEDUCTIBLE
$
X RETENTION $10,000 $
C WORKERS COMPENSATION AND UB7082Y944 0910112009 09/0112010 X WCSTATU- OTH-
EMPLOYERS' LIABILITY
-ANY-PROPMETOWF*ARTNERIEXECUTIVE E
L
EACH ACCIDENT $1 OOO
OOO
OFFIC?
Ee/MF
Mghp EXCLUDED? N ,
, ,
.n))
ao
( an ry E
L
DISEASE - EA EMPLOYEE $1
000
000
If yes, describe under .
. ,
,
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $1,000,000
A OTHER Professional ENVO106240905 09/02/2009 09/02/2010 $1,000,000 per claim
Liability $1,000,000 annl agg r.
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
** Workers Comp Information **
Part 1 states: all states
Insured has reason to send employees out-of-state to any Given state.
City of Clearwater
Attn: City Clerk
PO Box 4748
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Clearwater, FL 33758.4748 REPRESENTATIVES,
AUTHORIZED REPRESENTATIVE
ACORD 25 (2009/01) 1 of 2 #S258809/M258798 Q 1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD LWA
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.
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