CERTIFICATE OF LIABILITY INSURANCE (156)ACORD
CERTIFICATE OF LIABILITY INSURANCE TDDIATE(MMIDDNYYY)
.,.
PRODUCER Phone: 727 461-6044 Fax: 727 442-7695 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Brown & Brown Insurance - Clearwater ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
jmiller@bbpinellas. com ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P 0 Box 2456
Clearwater FL 33757-2456
INSURERS AFFORDING COVERAGE
NAIC #
INSURED INSURERA:Hart ford Fire Insurance- Co. 19682
Kisinger Campo & Assoc. Corp. INSURERB:Hartford C ualty Insurance C _ 424
KCCS, Inc
INSURER C:Continental Casualty Co. ___
0443
201 N. Franklin Street, Ste 400
a FL 33602
Tam INSURER D:
.
p
INSURER E:
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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 DD'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
A X GENERAL LIABILITY 21UUNAG7 5 4 7 9/1/2010 9/l/2011 EACH OCCURRENCE $1,000, 000
COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $100,000
- CLAIMS MADE IX OCCUR MED EXP (Any ona person) $ 10, 000
PERSONAL & ADV INJURY $ 1 0 Q L-10 0
GENERALAGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000.000
X POLICY jR? 71 LOC
AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANYAUTO O\? (Ea accident)
rrp 2
ALLOWNEDAUTOS s?\ BODILY INJURY
$
SCHEDULEDAUTOS RY15 AND (Perperson)
HIRED AUTOS r6.,11r`^ 'ECO
("1f+f'//--yyee'r?p
0CS DOI
BODILYINJURY
$
NON-OWNED AUTOS ?v
J
J? IE
G&J^?
(Peraccldent)
V
E
PROPERTY DAMAGE
(Par accident) $
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
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 $3-0,000 $
A WORKERS COMPENSATION AND 21WBNW1033 10/3/2010 10/3/2011 }{ WC5LIMTT- OEH-
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$500,000
ANY PROPRIETOR(PARTNERIEXECUTIVE
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE- POLICY LIMIT
$ 5 0 Q Q Q
C OTHER EH288295813 11/2/2009 11/2/2010 Per Claim 2,000,000
Professional Liability Aggregate 5,000,000
Claims Made Deductible 200,000
DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS
Certificate Holder is an additional insured with respect to general liability and umbrella liability. Endorsements
available upon request. Waiver of Subrogation applies to general liability and workers compensation- *10 Days for Non
Payment.
Services under Engineer of Record Agreement, RF4 #12-09 (KCA #6200905.00)
r+eaTletrATC unl neo CONCPI I ATIAN
------- ---------- ---
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. 0. 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
za'om R. of
ACORD 25 (2001/08) @ACORD CORPORATION I9SS
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).
_v. 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.
UUKU LS (LUUI/UU)