CERTIFICATE OF LIABILITY INSURANCE (148)a- Client#: 1408018 131 BAKERBAR
DATE (MM/D
ACORD- CERTIFICATE OF LIABILITY INSURANCE 9/
01/2010)
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
BUT - J. Rolfe Davis ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
PO Box 4927 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Orlando, FL 32802.4927
407 691-9600 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Hartford Casualty Insurance Corn 29424
Baker Barrios Architects Inc INSURER B: Maryland Casualty Company 19356
189 S. Orange Avenue,Ste #1700 INSURER C:
Orlando, FL 32801
INSURER D:
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 NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
DATE MM DATE MM D YY LIMITS
A GENERAL LIABILITY 21SBAUF6297 11/15/2009 11/15/2010 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY .. .. .. - DAMAGE TO RENTED
-PREMISES (Ea occurrencel $1 000 000
I CLAIMS MADE 51OCCUR MED EXP (Any one person) $10 000
PERSONAL R ADV INJURY $1
000
000
GENERAL AGGREGATE ,
,
$2
000
000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG ,
,
$2,000,000
POLICY F XI LOC
AUTOMOBILE LIABILITY
ANY AUTO C(/'?
RECE"
IwVVV...///
ED
COMBINED
(Ea accident) INGLE LIMIT
$
ALL OWNED AUTOS
SCHEDULED AUTOS
p 0 8
201 BODILY INJURY
person)
$
HIRED AUTOS SE P
SE
NON-OWNED AUTOS
DS A14D BODILY INJURY
(Per accident) $
OFFICIAL RECO R
LEGIC1 ATK C J
JIJ1I I r Ir CS DEPT PROPERTY DAMAGE
(Per accident) $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO EA ACC
OTHER THAN $
AUTO ONLY, AGG $
A EXCESS I UMBRELLA LIABILITY 21 SBAUF6297 11/15/2009 11/15/2010 EACH OCCURRENCE $5,000.000
X OCCUR ? CLAIMS MADE AGGREGATE $5 000 000
DEDUCTIBLE $
_ . -X. -RETENT10N.......$_10.O00_ ._.. - - - - - - -- - - - ---- -- -$ - -'- ---- - - =-
B WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY WC0253005503 09101/2010 09/01/2011 X OR NCYS OTH-
I FIR
ANY PROPRIETOR/PARTNER/EXECUTIVE ryi?
FIC E.L. EACH ACCIDENT $1,000,000
EatoR/Mrym FIn NH I EXCLUDED? y
Mand E.L. DISEASE- EA EMPLOYEE $1,000,000
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$1,000,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
City of Clearwater
Attn; City Clerk
P O Box 4758
Clearwater, FL 33758
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3_ 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
AUTHORIZED REPRESENTATIVE
m,%jR" Cv lcwm01) 1 of 2 #55542655/M5435180 Q 1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD EMTU
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.
AULIKU L* (ZUUV/U9) 2 of 2 #S5542655/M5435180