CERTIFICATE OF LIABILITY INSURANCE (158)Client: 6108
GRIMCRA3
ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE
'
10
/01/2010
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 22668 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tampa, FL 33622-2668
813 289.5200 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Phoenix Insurance Company 25623
Grimail Crawford, Inc. INSURER B: Travelers Casualty and Surety C 19038
1511 N Westshore Blvd INSURER c. Everest National Insurance Comp 10120
Suite 1115
INSURER D:
Tampa, FL 33607
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUREMENT, 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 PDpLTEYMMVDl7mE PDATE MM/IDD/YYI LIMITS
A GENERAL LIABILITY 680528OL540 10/14/10 10/14/11 EACH OCCURRENCE $2,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $1,000,000
...' CLAIM,$ MADE.... OCCUR MED EXP (Any-one person)- $10,000 . ... -.
PERSONAL & ADV INJURY s2,000,000
GENERAL AGGREGATE s4,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s4,000,000
I El POLICY PERCT O LOC
J
AUT OMOBILE LIABILITY '?.
M COMBINED SINGLE LIMIT
ANY AUTO .
r,
o
?i, F,..:. .. (Ea accident) $
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS % (Per person) $
0 T 4 2016
O
HIRED AUTOS tiJ BODILY INJURY
NON-OWNED AUTOS
ryy
I?
(Per accident) $
O
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I PROPERTY DAMAGE
LEGIS TIME 5RVC5 D EFT (Per accident) $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR L1 CLAIMS MADE AGGREGATE $
H DEDUCTIBLE $
RETENTION $ $
B WORKERS COMPENSATION AND UB610OY759 05/22110 05122/11 X WTORY C LIMIT ER
-- EMPLOYERS' LIABILITY
P
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tOR
'rlGE - _
+
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y-ACCIDENT- ?._.
.$ _.?...-.
ANY PI
OPRIE
/
AR
NER/EXE
U
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1,000,000
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
1$1,000,000
C OTHER Professional 79AE000413101 05/29/10 05/29/11 $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 written on a claims made and reported basis.
RE: City of Clearwater Engineering of Record
City of Clearwater
Engineering Dept. Ste. 200
Attn: Susan Chase
PO Box 4748
Clearwater, FL 33758-4748
L;ANL:tLLAIIUN iu UaVS Tor
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ W 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
REPRESENTATIVES.
AUTFjORIZED REPRESEIITATIVE
pL51;P 'I?. Qd?.pL.o
ACORD 25 (2001/08) 1 of 2 #S275809/M275803 MRL o ACORD 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-S (2001/08) 2 of 2 #S275809/M275803