CERTIFICATE OF LIABILITY INSURANCE (146)ACORD
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
TM 8/31/2010
PRODUCER Phone: 727 461-6044 Fax: 727 442-7695 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Brown & Brown Insurance - Clearwater
jmillerc?bbpinellas - com ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P O Box 2456
Clearwater FL 33757-2456
INSURERS AFFORDING COVERAGE NAIC #
INSURED
INSURER A: Hartford Fire Insurance Co. _
19682 -
Kisinger Campo & Assoc. Corp. INSURER B: Hartford Casualty Insurance C 9424
KCCS, Inc _
Franklin Street
201 N
Ste 400 INSURERC:Continental Casualty Co. 0443
.
, W _
'Pampa FL 33602 INSURER D:
_
INSURER E:
i
F-,---
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 o.
L
NSRD
TYPE OF INSURANCE
POLICY NUMBER POLICY EFFECTIVE
'DATE(MM/DDffY) POLICY EXPIRATION
DATE (MM/QD. X)
LIMITS
--
-x--=
GE?ERAt LIABItIT,r ----=
2-rte°5 4 r° - - ? -
9 r- zo 10 - , - --
?t-r mrt? EACH-OCCURRENCE - - "
? ?o-o- --oD-o--.. _
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $100, 000
CLAIMS MADE FXOCCUR MED EXP (Any one person) $ 10, 0 0 0
PERSONALAADVINJURY $1,000, 000
GENERAL AGGREGATE $ 2?0 0 Q Q 0
GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS -COMP/OPAGG $2,000,000
X POLICY' PRO-
J T LOC
AUT OMOBILE LIABILITY RECI MIJ COMBINED SINGLE LIMIT
$
ANY AUTO (Ea accident)
ALL OWNED AUTOS
SCHEDULEDAUTOS
SEP 1
112010 BODILY INJURY
(Per person)
$
HIREDAUTOS _
BODILY INJURY
$
NON-OWNEDAUTOS OFFICIAL RE CORDS AN (Per accident)
LEGISLA SRVCS DE PROPERTY DAMAGE
(Per accident) $
GA RAGE LIABILITY AUTO ONLY _-_EA_ACCIDENT
?? S
ANY AUTO EAACC
OTHERTHAN $
AUTOONLY: AGG 8
B X EXCESS/UMBRELLA LIABILITY 21XHUAG7 6 0 7 9/1/2010 9/1/2011 EACH OCCURRENCE $3,000,000
X_ OCCUR CLAIMS MADE AGGREGATE $3,000,000
$
DEDUCTIBLE
RETENTION $10,000 $
TH-
Nt9RKER&.60MPENSA710NAtrB----•?.
( ?`...._.._..?-?. ?...... .13- y
? / ?+ ZD_ '1- _ LI 5T
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EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$ 5 0()000
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $500, 000
If yes, describe under
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $SOO. 000
C OTHER
EH288295813
11/2/2009
11/2/2010 Per Claim
2, 000,000
Professional Liability ?ggregate 5,000,000
Claims Made ( Deductible 200,000
DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
Certificate Holder is an additional insured with respect to general liability, auto liability and umbrella liability.
Endorsements available upon request. Waiver of Subrogation applies to general liability and workers compensation- *10
Days for Non Payment.
ervices• under Engineer of Record Agreement, RFQ #12-09 (KCA #6200905.00)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER
City of Clearwater WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN NOTICE TO THE
Attn: City Clerk CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO
P. O. Box 4748 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON
Clear water FL 33758-4748 THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
f?]
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ACORD 25 (2001/08)
OACORD CORPORATION 1988
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 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 (2001/08)