CERTIFICATE OF LIABILITY INSURANCE (188)rliant#• APAARA
IFrrFRRA
ACORD. CERTIFICATE OF LIABILITY INSURANCE DA
i22io o?
o
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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).
PRODUCER NACONTACT
ME:
USI Ins. Services of CT, Inc. PHONE
No Exl : 203 634-5700 A/C No : 2036345701
530 Preston Avenue F-MAIL
ADDRESS:
Meriden, CT 06450
CUSTOMER ID
203 634-5700
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A: Hartford Fire Insurance Co 19682
a
ars & Graham, Inc. INSURER B: Hartford Casualty Insurance Com 29424
4 Research
4
Drive INSURER C : Hartford Accident & Indemnity C 22357
Suite 301
INSURER D: Chartis Specialty Insurance Com
26883
Shelton, CT 06484
INSURER E :
INSURER F :
COVERAGES - - CERTIFICATE NUMBER
-RFVlfilnN NUMYRFI3-
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
L INSR TYPE OF INSURANCE INSIR POLICY NUMBER POLICY Y 9 EM ( POLICY M p YY LIMITS
A GENERAL LIABILITY 31UUNZK6256 11/01/2010 11/01/2011 EACHOCCURRENCE 81000000
X COMMERCIAL GENERAL LIABILITY
DAMAG5T
P
REMISES Eaoxurrence
$300000
CLAIMS-MADE 1:9 OCCUR MED EXP (Any one person) $10,000
X contractual PERSONAL & ADV INJURY $1,000,000
X X,C,U included GENERALAGGREGATE s3,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP/OPAGG $3000000
POLICY PRO LOG 1=111=11 MCI $
B AUT OMOBILE LIABILITY 31 UEN ,-: 1/01/2010 11/01/2011 COMBINED SINGLE LIMIT $
X (Ea accident) 1
ANY AUTO BODILY INJURY (Per person) S
ALL OWNED AUTOS OV I 6 Q? "?O?0 (t
[ BODILY INJURY (Per accident) $
SCHEDULED AUTOS PROPERTYDAMAGE
X
HIRED AUTOS
(Per accident) S
X NON-OWNED AUTOS OFFICIAL RE ''(DRDS D $
LEGISLATIVL,,),RN'C5 D EPT $
B X UMBRELLAUAB X OCCUR 31XHUFC0726 11/01/2010 11/01/2011 EACHOCCURRENCE $10000000
EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000
DEDUCTIBLE $
X RETENTION $ 10000 $
C WORKERS COMPENSATION
ILIT
AND EMPLOYERS' 31WENJOS22 11/01/2010 11/01/2011 X wcSTATU• OTH-
ANY PROPRIETOR/PARTNEFVEXECUTIVE
N /A
E.L. EACH ACCIDENT
S-1,000,000
EXCLUDEDT
(Mandatory In NH) N
. . ... _ .. ..:_ .. _ __.... .. _ .. _.... .. _ ._. ___ ..
E.L. DISEASE - EA EMPLOYEE
0 WO 000
DESCR Ne under
OF 9.E 0 S below
E.L. DISEASE - POLICY LIMIT 1
$1,000,000
D Pollution/Profess COPS3778313 /17/2009 06/17/2011 $5,000,000/$5,000,000
Liab-Claims Made Deductible $50,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
City of Clearwater is named as Additional Insured with respects to the above General Liability and
Automobile policies when required by written contract In accordance in policy terms, conditions and
exclusion.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: City Clerk
P.O. Box 4748 AUTHORIZED REPRESENTATIVE
CLEARWATER, FL 33758-4748 ?s?rsy?lrffff 1
01988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S4932327/M4928355 P21 JA
This page has been left blank intentionally.
USI Ins. Services of CT, Inc.
530 Preston Avenue
Meriden, CT 06450
203 634-5700
City of Clearwater
Attn: City Clerk
P.O. Box 4748
CLEARWATER, FL 33758-4748