CERTIFICATE OF LIABILITY INSURANCE (159)
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CERTIFICATE OF LIABILITY INSURANCE FATE(MM/DD/YYYY)
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PRODUCER
Aon Risk Insurance Services west, Inc.
Aon
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
Portland Oregon Office AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
851 SW 6th Avenue CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
Suite 385 COVERAGE AFFORDED BY THE POLICIES BELOW.
Portland OR 97204-1309 USA
INSURERS AFFORDING COVERAGE NAIC#
PHONE-C503) 224-9700 FAx 503 295-0923
INSURED INSURERA: Lexington Insurance Company 19437
TBE Group, Inc. Cardno TBE INSURER 13; American Economy Ins Co 19690
380 PARK PLACE BLVD.
SUITE 300
,
CLEARWATER FL 33579 USA INSURER C: American States ins Co 19704 y
b
INSURER D. Travelers Property Cas Co of America 25674
INSURER E: Liberty Mutual Fire ins CO 23035
CnVF.RAGF.C SIR aoolieS Der terms and conditions of ThP nnlirv
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 TILE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED
INSR D
D 1
LTR J'S TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
AT M/DD/YYY DAT MM/DD/YYYY
D ERAL LIABILITY 68018931-12010 09/30/2010 09/30/2011 EACH OCCURRENCE $1,000,000
X GL (AOS)
D COMMERCIAL GENERAL LIABILITY 68019121_57A10 09/30/2010 09/30/2011 DAMAGE TO RENTED $1,000,000
GL (CA) PREMISES (Ea occurrence)
CLAIMS MADE OCCUR
6802248U2
10
09
30
2010 MED EXP (Any one person) Q?
D X No Deductible A
GL (FL) /
/ 09/30/2011
PERSONAL & ADV INJURY
$1,000,000
D PACP1920L96210 09/30/2010 09/30/2011
GENERAL AGGREGATE
$2
000
000
' GL (TX) ,
,
GEN
L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGO
$2,000,000
E] POLICY ® PRO- ? LOC
IECT
B AUTOMOBILE LIABILITY 02CE213172-20 09/30/2010 09/30/2011
ANY AUTO
Auto (AOS) COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
e 02CE213192-20 09/30/2010 09/30/2011
X ALL OWNED AUTOS Auto (GA) BODILY INJURY
B X SCHEDULED AUTOS 02CE213201-20 09
0
330//2
//
1100 09/30/2011 (Perperson)
(LA)
Auto
c X HIRED AUTOS 0101
1CI285296-20
RE /3
?J{
?20
'
`
E 09/30/2011 BODILY INJURY
)(
NON OWNED AUTOS
Auto (N]) ¦ . ?n+
(Per accident)
B 02CE213191
20 09/30
2010 09
3
2
$1,000 camp/Loll [led -
Auto (VA) / /
0/
011
PROPERTY DAMAGE
C 15 2010 (Per accident)
GARAGE LIABILITY
I
IAL
RECORDS
D AUTO ONLY - EA ACCIDENT
ANY AUTO C
OFF
EGISLA E SR`/CS DE PT EA ACC
OR
T
ILY
L :
0
O
N
AGG
E EXCESS/UMBRELLA LIABILITY TH2661066161010 09/30/2010 EACH OCCURRENCE 35,0007M
OCCUR ? CLAIMS MADE AGGREGATE $5,000,000
DEDUCTIBLE
_w_.
-
sio
--------•
-
- - --
RETENTION
F 5 WELR1509 09/30/2010 U'J/JU/ZUII x WC STATU- OTH.
WORKERS COMPENSATION AND
'
Y
JMIT5
EMPLOYERS
LIABILITY
N
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$1,000,000
OFFTCER/MF.MBER EXCLUDED?
(Mandatory in NH) E.L. DISEASE-EA EMPLOYEE $1,000,000
if yes, describe under SPECIAL PROVISIONS below E.L. DISEASE-POLICY LIMIT $1,000,000
A 013001507 11/26/2009 Each claim $5700,000
OTHER Includes Pollution Liab.
Aggregate $5,000,000
Archit&Eng prof
SIR $250,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
City of Clearwater is listed as additional insured with respect to the General, Auto and Excess Liability
policies. Waiver of subrogation in favor of the additional insured applies to the General, Auto and Excess
Liability policies. This insurance is primary and non-Contributory over any other insurance maintained by
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1. hIK I It IUA IL h JIULLEt'R C "C ELLATIUN
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Attn : City Clerk DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
PO Box 4748 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Clearwater FL 33758-4748 USA BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE 'Q r. ?saetects?aAa 19.a4.
ACORD 25 (2009/01) 01988-2009 ACORD CORPORATION. All rights reserved
The ACORD name and logo are registered marks of ACORD
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
This 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.
...-. .. ,_ _-_.- --. --
ACORD 25 (2009/01)
Attachment to ACO" Certificate for TBE Group, Inc. Cardno TBE
The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage
afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the policy.
INSURED
TBE Group, Inc. cardno TBE
380 PARK PLACE BLVD., SUITE 300
CLEARWATER FL 33579 USA
INSURER F Hartford casualty insurance Co 29424
INSURER
INSURER
INSURER
INSURER
ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD
certificate form for policy limits.
INSR
LTR ADD'L
BVSRD
TYPE OF INSURANCE POLICY NUMBER
POLICY DESCRIPTION POLICY
EFFECTIVE
DATE. POLICY
EXPIRATION
DATE
LIMITS
DESCRIPTION OF OPERATIONS/LOCATIONSNEiflCLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate holder.
Certificate No : 570040407836