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CERTIFICATE OF LIABILITY INSURANCE (167)
DATE (MM/DDNYM CERTIFICATE OF LIABILITY INSURANCE 5 2 2011 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. It SU6RtJGAI IUN IS VVAIVLU, suojeCT 110 the terns 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 Gillis of Illinois, Inc. ?33 S. Wacker Dr ate 2000 "_hicago IL 60606 INSURED H.W. Lochner, Inc. 20 N. Wacker Drive Suite 1200 Chicago IL 60606 TACT NAME: PHONE _ FAX IAtC_ No_ 3 -730 a/C No: 12- E4AAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSUREER A : n INSURER B : 4 ENSURER c INSURER D: - INSURER E INSURER F : r E00'rICICATI= MP IU 3ER- 1134 53663 -' .. ----.. _.- .... _-- --REVISION=NUMBER--- - I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURI INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS ILT R TYPE OF INSURANCE IN R WVD POLICY NUMBER MM/Dg EFF MMM//DCY EXP GENERAL UABILITY COMMERCIAL GENERAL LIABILITY CLAIMS-MADE 7 OCCUR GEN'LAGGREGATE LIMIT APPLIES PER: I POLICY E JJECOT LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON-OWNED HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EXCESS UAB CLAIMS-MADE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS Professional Liability I. ..r tti') 1?,,, , C pig d ?;, , ? j( i If-G4S1? 4177432 5/1/2011 /1/2012 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addrdonal Remarla Schedule, if more space is required) CERTIFICATE TION ?D NAMED ABOVE FOR THE POLICY PERIOD 70CUMENT WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS EACH OCCURRENCE $ DAMA D PREMISES occurrence $ MED EXP (Any one person $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OPAGG $ $ COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per ident $ EACH OCCURRENCE $ AGGREGATE $ $ WC STATU- OTH- LIM _ ..E.LEA U.ArCEDENT_.` .. E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ $1,000,000 Per claim $1,000,000 Aggregate 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. Attention: City Clerk P.O. SOX 4748 AUTHORIZED REPRESENTATIVE Clearwater FL 33758-4748 ©1988-2010 ACORD CORPORATIO ".I rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD