CERTIFICATE OF LIABILITY INSURANCE (144)rliant#- 32AR
AUDEROB3
ACORD. CERTIFICATE OF LIABILITY INSURANCE 07/22
2010 )
/
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 2266$ ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tampa, FL 33622-2668
813 289-5200 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Old Dominion Insurance Company 40231
Robert Aude Associates Inc AIA INSURER S! Travelers Casualty & Surety Co 19038
19353 U.S. Hwy 19 N., Ste 101 INSURER C: XL Specialty Insurance Company 37885
Clearwater, FL 33764 INSURER D:
INSURER E:
COVFRAGES
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
NSR
TYPE OF INSURANCE
POLICY NUMBER POLICY EFFECTIVE
DATE / POLICY EXPIRATION
IMMIDDIYYI LIMITS
A GENERAL LIABILITY BPG98417 07122/10 07/22/11 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $500,000
CLAIMS MADEaX OCCUR MED EXP (Any one person) $5,000
PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000
POLICY PRO LOC
A AUTOMOBILE LIABILITY B1 G98417 07/22/10 07/22/11 COMBINED SINGLE LIMIT
$1
000
000
X ANY AUTO (Ea accident) ,
,
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 $
AUTO ONLY: AGG $
A EXCESS/UMBRELLA LIABILITY CUG98417 07/22110 07/22/11 EACH OCCURRENCE $1,000,000
OCCUR O CLAIMS MADE AGGREGATE $1,000,000
DEDUCTIBLE $
RETENTION $ $
13 WORKERS COMPENSATION ANA UB7080Y385 - 09r/01/10 09/01/11 -
WC STATU- TH-
X
I FIR
-- -...
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $500,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
E.L. DISEASE - EA EMPLOYEE
$500 O00
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$500,000
C OTHER Professional DPR9686122 07/20110 07/20/11 $2,000,000 per claim
Liability $2,000,000 annl aggr.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Professional Liability is claims made and reported.
City of Clearwater is an additional insured w/respect to General Liability
and Auto Liability. Waiver of Subrogation is included except for Workers
Compensation.
City of Clearwater
Attn: City Clerk
P.O. Box 4748
Clearwater, FL 33758-4748
IOU "
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 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
AU ORIZED REPRESS TATIVE
I-P4 Wu
ACORD 25 (2001/08) 1 of 2 #S260921/M260920 KEB 0 ACORD CORPORATION 1988
?ITril M A CIM
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 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 (2001108) 2 of 2 #S260921/M260920