CERTIFICATE OF INSURANCE
oe-2~7200~ 03:41pm
PROOUCEiR (305)822-780) FAX 3058270585
Collinsworth, Alter, Fowler, Dowling
& French Group Inc.
P. O. Box 931s
Miami Lakes, FL 33014-9315
INSUREO Post, Bucl< ey, Schuh, & Jern gan, Inc.
d/b/a PBS&J
2001 NW 107 Avenue
Miami, FL 33172-2507
Frcm-PBS&J LEGAL ~IAMI
305-599-2739 T-981 P.002/003 F-363
-.. ..-.-- - · II .,,"". ""'1l'-'L; 08/27/2003
THIS CERTIFICATE IS ISSUED AS A MAnER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERnFICATE
HOLDER. THis CERllFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
INSURERS AFFORDING COVERAGE
INSURER A; Continental Casualty Company A X
INSURERB: Nat'l Union Fire Ins Co-Pittsbur
INSU~c: American Casualty Co Reading A l(
INSURl'R D; L 1 oyds of London A- XV
INSURJ;R E:
NAIC#
h PA A++ X'
COVeRAGES ,
THE POLICIES OF INSURANCE LISTEO 8ElOW HA~ BEEN ISSUED TO TI-IE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDIN
ANY REQUIREMENT. lERM C R CONDITION OF AN\' CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WfilCH TfoUS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURAI\CJ: AFFORDED BY TH~ POLICIES DESCRIBED Hf;REIN IS SUBJECl TO AU. lHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGREGATE L1Mr's SHOWN MAY HAVE BEEN REDUCEO BY PAlO CLAIMS.
INSR 00' TYPE OF It-lSUR 'Nce POLICY NUMBER POLICY EFFI'CTlVE POLICY l!XPIRATION UMITS
GENERAl. LIABILITY Gl247841206 09/30/2002 09/30/2003 ~CH OCCURReNCE S 1.000,00(]
X COMMeRCIAL GENe AAL L1AaILIT'f ~~~~iJO RENTED " 1 OOO,OOC:
..
~ ~ CI.AIMS MADE W OCCUR MEO EXP (Any ona per'$Qn) ,. 2S,00O
A - PERSONAL & ADV INJuRy 1,000,00(
,.
"
GENERALAGGREGAiE I 2,OOO,OO(
GEN'L AGGREGATe LIMIT APPLIES PE~ PROOueTS . COMP/OP AGG ~ 2,000,000
Ii POLICY m ~~T m LOC '.'
.
AUTOMOBll-i UABILl'fY BUA247843223 09/30/2002 09/30/2003 COMBINED SINGLE LIMIT
X ANY AUTO [Ea accldenl) $ 1,000JOOO
7 ALL OWNED AUTOS BOOIl- Y IIIlJURV
- (Per person) $
SCHEOULED AUTOS
A rx HIREiD AUTOs
IlOOIL Y INJURY $
ty NON-OWNED AiJTOS (Per 8CC1denl'
-
- P~OPERTY DAMAGE $
(Per a"i~Qnl)
.
GARAGE I-IABllITY AUTO ONL'y - EA ACCIDENT $
q ANY AUTO OTHER lHAN EA ACC $
AUTO ONLY; AGG $
,. BE2U1609 09/30/2002 09/30/2003 10,000,000
EXCESS/UMBRELLA L1A81-1TV EACH OCCURRENCe $
t!J OCCuR 0 CI.AlMSMADE AGGReGATE $ 10,000.000
B $
R DEDlJC'1'1BI-E S
RETENTION $ $
WORKliRS COMPENSATION AND WC247843168 09/30/2002 09/30/2003 X I WCSTATU. I joJ;tl-
EMPLOYERS' LIABILITY E.L. EACH ACCIOI!NT $ 1,000,000
C ANY PROPRlETORlF'ARTNmeXE CUTIVE
OFFICER/MEMBER EXCLuoeo? E.L DISEASE - EA EMPLOYEE $ 1,000,000
It ~5, llesc~bc under IH. DISEASE" POLICY LIMIT $ 1,000,000
S CIA!- PROVISIONS belgw
Po;~~ssional and P42302 09/30/2002 09/30/2003 $1,000,000 L.imits
D Pollution liabilit} Ea Claim and Annual Aggregate
CI,..AIMS-MADE FORM 11/11/1961 Retrodate
DESC:RIP'rION OF OPliRATIONs I LOCA'lONS I VEHlCI-aS f EXCLlllilONS ADDED BY ENDORSl'MENT I SPECIAl, PAOIIISIONS
~ef: City of Clearwate",
:ertificate Holder is lamed as addiqonal insured on the General II Auto liability, excluding
Irofessional services.
CERTIFICATE HOLDER
City of Clearwat~r - Engineer Qf Record
100 S. Myrtle AVlue
Engineering - Suite 220
o earwater , FL ll756
SHOULO ANY 01" THE ABOVE Dl'SCRlBED POLICIES 8E CANCEl.LEO 115FORE THE
l'XPlAA11ON DATIl THEREOF. TH!! !$SUING INSURER WILL ENDEAVOR TO MAIL
-1L DAYS WRm'EN NOTlCf;! TO THE CEIlTIFlCAlE tlOLDiR NAMEII TO THE lEFT,
IlUT FAILURE TO MAIL SUCW NOTICE SHALL IMPOSE NO OBlIGA'l'ION ,~A LlAJIILI'l'V
01" AN'( KIND UPON THE INSURER, ITS AoeNTS OR REPRE6ENTATtV!t.
AlITliOIUZf!D /U!f'~NTATlve crY\ . ~ _n _ (\ A /Ill.. :. _ .. , l
W, Meade Collinsworth~."UI ~~~~
@ACORD CORPORATION 1988
~CORO 25 (2001/08)
OS-2~-2002 03:41pm Frcm-PBS&J LEGAL ~IA~I
.,.
305-599-2739
T-981 P. 003/003 F-363
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this ce 1ificate does not cMfer rights to the certificate holder in lieu of such endorsement(s).
If SUBRO~ATION IS WAIVED, sUbject to the terms and conditions of the policy, certain policies may
require an endorsement A s'~tement on this certificate does not confer rights to the certificate
holder in lieu of such endors&ment(s).
DISCLAIMER
The Certifj, ~ate of Insurance On the reverse side of this form does not constitute a contract between
the Issuing insurer(s), authori.;~ed representative or producer, and the certIficate holder, nor does it
affirmatively or negatively am4md, extend or alter the coverage afforded by the policies listed thereon.
CORD 25 (2001/08)