CERTIFICATE OF INSURANCE (8)
DATE (MM/DDNYYY)
09/30/2003
THIS CERTIFICATE IS ISSUED AS A MATTE~ OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
CERTIFICATE OF LIABILITY INSURANCE
PRODUCER (305)822-7800 FAX 3058270585
Collinsworth, Alter, Fowler, Dowling
& French Group Inc.
P. O. Box 9315
Miami Lakes, FL 33014-9315
INSURED Post, Buckley, Schuh, & Jernigan, Inc.
d/b/a PBS&J
2001 NW 107 Avenue
Miami, FL 33172-2507
INSURERS AFFORDING COVERAGE
INSURERA: Conti nenta 1 Casualty Company A X
INSURERB: American Casualty Co Reading A X
INSURER C: L 1 oyds of London A- XV
NAIC#
INSURER 0:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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.
II~~: ~'?:~~ TYPE OF INSURANCE POLICY NUMBER PRHSY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY GL247843206 09/30/2003 09/30/2004 EACH OCCURRENCE $ 1,000,000
I-- DAMAGE TO RENTED o.
X 0 COMMERCIAL GENERAL LIABILITY $ 1,000,000
I-- h CLAIMS MADE m OCCUR
MED EXP (Anyone person) $ 25,000
A X Contractual Liab PERSONAL & ADV INJURY $ 1,000,000
I--
GENERAL AGGREGATE $ 2,000,000
I--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
h 0 [Xl PRO- m LOC
POLICY JECT
AUTOMOBILE LIABILITY BUA247843223 09/30/2003 09/30/2004 0
~ ANY AUTO COMBINED SINGLE LIMIT $
(Ea accident) 1,000,000
X ALL OWNED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AUTOS
A -
X HIRED AUTOS BODILY INJURY
X (Per accident) $
NON.OWNED AUTOS
X Contractual Liab PROPERTY DAMAGE
- (Per accident) $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
==i ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY CUP2068179760 09/30/2003 09/30/2004 EACH OCCURRENCE $ 10,000,000
~ OCCUR o CLAIMS MADE AGGREGATE $ 10,000,000
A $
~ DEDUCTIBLE $
X RETENTION $ 10,00C $
WORKERS COMPENSATION AND WC247843268 09/30/2003 09/30/2004 X I TVj,~~T ~:I~-;, I IOJ~'
EMPLOYERS' LIABILITY 1,000,000
B ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? NO E.L DISEASE - EA EMPLOYEE $ 1,000,000
If yes, describe under E.L. DISEASE. POliCY LIMIT $ 1,000,000
SPECIAL PROVISIONS below
OTH~ P42303 09/30/2003 09/30/2004 $1,000,000 Limits
Pro essional/Pollution
C Liability Ea Claim and Annual Aggregate
CLAIMS-MADE FORM 11/11/1961 Retrodate
I)~ESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
ef: City of Clearwater. rn B;.~5n:l-~
ertificate Holder is named as additional insured on the General & Auto liabil
professional services.
CERTIFICA TE HOLDE~ r.ANCELLA TION rITYOF~~
SHOULD ANY OF THE ABOVE DESCRIB
Clearwater, City of EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL.ENDEAVOR TO MAIL
Engineer of Record ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
100 S. Myrtle Avnue BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
Engineering - Suite 220 OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
Clearwater, FL 33756 AUTHORIZED REPRESENTATIVE Jf74~!c+;ii:;N'/
Meade Collinsworth/EEC I
ACORD 25 (2001/08)
@ACORDCORPORATION 198B