CERTIFICATE OF LIABILITY INSURANCE (111)Client#: 3206
ACORD. CERTIFICATE OF LIP
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AI
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EX
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the po
the terns and conditions of the policy, certain policies may require an sin
certificate holder In lieu of such endorsement(s).
PRODUCER
ISU Suncoast Insurance Assoc
P.O. Box 22668
Tampa, FL 33622-2668
813 289-5200
INSURED
Robert Aude Associates Inc AIA
The Brentwood Studio
1719 Brentwood Dr
Clearwater, FL 33756
COVERAGES CERTIFICATE NUMBER:
A 1 IneOnQ4
DDNYYY)
BILITY INSURANCE DATE (MMI
,
20
0 CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
SEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
lcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
dorsement. A statement on this certificate does not confer rights to the
CONTACT
NAME:
813 289-4561
PHONE 813289-5200
AIC No Ext pIC Na :
L
ADDRESS:
CUSTOMER ID #:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A:Old Dominion Insurance Company 40231
INSURER B : Travelers Casualty & Surety Co 19038
INSURER C : XL Specialty Insurance Company 37885
INSURER D :
INSURER E :
INSURER F :
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEKIUu
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.
INSR kDDLBUBR POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE p POLICY NUMBER MMIDDIYYYY MM/DDIYYYY
A GENERAL LIABILITY BPG98417 7/22/2010 07/22/2011 EACH OCCURRENCE $1,000,000
X
COMMERCIAL GENERAL LIABILITY DAMAGE O
PREMISES Ea occurrence
$500000
CLAIMS-MADE Fx_]OCCUR MED EXP (Any one person) $5,000
PERSONAL SADVINJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
POLICY PRO LOC $
A AUT OMOBILE LIABILITY B1 G98417 07/22/2010 07/22/2011 COMBINED SINGLE LIMIT
(Ea accident) $
000
000
1
X ANY AUTO ////hhhh
RECEVE BODILY INJURY (Per person) ,
,
$
ALL OWNED AUTOS BODILY INJURY (Per accident) $
SCHEDULED AUTOS Y DAMAGE $
X HIRED AUTOS r? 0
MAR 2 (Per accident)
X
NON-OWNED AUTOS $
AND
$
A UMBRELLA LIAR X OCCUR CUG98? $? C i 010 07/22/2011 EACH OCCURRENCE $1,00 0 000
EXCESS LIAR CLAIMS-MADE AGGREGATE $1,000,000
DEDUCTIBLE a
RETENTION $ $
B WORKERS COMPENSATION UB708OY385 9/01/2010 09/0112011 X WC STATU- OTH-
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNERIEXECUTIVEY
E.L. EACH ACCIDENT
$500,000
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH) N/A
E.L. DISEASE - EA EMPLOYEE
$500,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$500,000
C Professional
Liability r ?5686122 7120/2010 07/20/2011 $500,000 per claim
$500,000 annl a r.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
Professional Liability coverage is written on a claims-made and reported basis.
City of Clearwater is an additional insured w/respect to General Liability
(See Attached Descriptions)
CERTIFICATE HOLDER t.AN4CLLAIIUN
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Attn: City Clerk ACCORDANCE WITH THE POLICY PROVISIONS.
P.O. Box 4748
Clearwater, FL 33758-4748 AUTHORIZED REPRESENTATIVE
(9) 1988-2009 AGORD GOKPUKA I IUN. All rlgnts reservea.
ACORD 25 (2009109) 1 of 2 The ACORD name and logo are registered marks of ACORD
#S309292/M309289 KEB