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CERTIFICATE OF LIABILITY INSURANCE (170)Client: 2476 HARVJOL3 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) , ti ?. 5/24/2011 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. 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 NAME: ISU Suncoast Insurance Assoc PHONE 813 289.5200 AN No Exl : A/C, No : 813-289561 P.O. BOX 22668 E-MAIL ADDRESS: Tampa, FL 33622-2668 CUSTOMER ID M 813 289-5200 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A, Phoenix Insurance Company 25623 Harvard Jolly, Inc. INSURER B: Commerce 8r Industry Ins Co 19410 2714 Dir Martin Luther King Jr St N INSURER C, Travelers Casualty & Surety Co 19038 St Petersburg, FL 33704 INSURER D : XL Specialty Insurance Company 37885 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 TE RMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF INSURANCE &DDL SUBR POLICY NUMBER POLICY MM/DDfYYYY) EFF NNQR EXP LIMITS A GENERAL LIABILITY X X 680170913725 11/08/2010 11/08/2011 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $1 Z000,000 CLAIMS-MADE 4 OCCUR MED EXP (Any one person) $10 000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ECERf PRODUCTS - COMP/OPAGG $2,000,000 POLICY X PRO LOC $ AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ AN g n f , - (Ea accident) Y AUTO l ' v L d BODILY INJURY P ALL OWNED AUTO . . ( er person) $ S SCHEDULE A _ BODILY INJURY (Per accident) $ D UTOS 'A' OR C " ICIML S AND PROPERTY DAMAGE - $ HIRED AUTOS pp C?/'±' A?ry/ Z -, s IS A E (Per accident) LEV L I y \ J DGfEr tl C NON-OWNED AUTOS $ $ B X UMBRELLA LIAB X OCCUR X EBU012733578 11/08/2010 11/08/2011 EACH OCCURRENCE s4 000 000 EXCESS LIAR CLAIMS-MADE AGGREGATE , , s4000 000 - , DEDUCTIBLE RETENTION $ $ C WORKERS COMPENSATION X UB5238Y87 1/01/2011 01/01/201 X WCSTATU- OTH- ' AND EMPLOYERS LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT NIA $1 000 000 , , OFFICERIMEMBER EXCLUDED? (Manda (Mandatory ory In In N NH) E.L. DISEASE - EA EMPLOYEE $1,000 000 If yes, describe under , DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 D Professional X DPR9685809 6/30/2010 06/30/2011 $3,000,000 per claim Liability $3,000,000 annl a r. DESCRIP'T'ION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required) RE: Architect of Record Agreement RFQ 14-11 Professional Services. The City of Clearwater Is listed as an Additional Insured as respects the Commercial General Liability and Excess Liability policies where (See Attached Descriptions) City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: City Clerk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Post Office Box 4748 Clearwater, FL 33758.4748 AUTHORIZED REPRESENTATIVE ®1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) 1 of 2 The ACORD name and logo are registered marks of ACORD .. #S320394/M287023 LWA ..... r Irrrr.vv? A. VIA #532039 4/M287023 ACC)R° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 05/24/2011 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(les) 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 endorsements . PRODUCER Mutual Insurance Inc CONTACT Mitchell Marsh 19001st Ave North P I= No Ext), W, HONE (727) 896-0006 FAX (727) 821-7483 PO Box 12350 AE-MAIL ODRE mmarsh@mutualinsuranceinc.Com St Petersburg FL 33713 NG v GE NAIC # INSURER A. Auto Owners Insurance Co INSURED Harvard, Jolly, Inc. INSURER C 27 - - FL 33704472 _ .. _._: St Petersburg -- _ - - - -- •- .. _?-- .. ?_ _ - INIJURfio E: -- _. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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- INSR ADDL SUBR POLICY EPF POLICY EXP TYPE OF INSURANCE LIMITS GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED MMERCIAL GENERAL LIABILITY $ CLAIMS-MADE OCCUR MED EXP An one arson $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE S GEN'L AGGRE GATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG PO Y PRO 0 IFr.T $ A AUT OMOBILE LIABILITY 9677117000 2010 ; 11/0812011 COMBINED SINGLE LIMIT ANY AUTO /?P N I C C It BODILY INJURY (Per person) $ 1,000,000 I ALL OWNED AUTOS SCHEDULED AUTOS "' BODILYINJURY(Peraccident) $ 1,000,000 X X NON-OWNED PROPERTY DAMAGE S 1 000 000 HIREDAUTOS , , 7 , 20111 $ UMBRELLA LIAR OrCUR EACH OCCURRENCE EXCESS LIHB H CLAIMS, -MADE ?J1 i ;CAL RE?..aJ dS ANC AGGREGATE $ - -A ORKER COMPENSATION- ' r WC STATU- OTH- ANDEMPLOYERS LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA (Mandatory In NH) E.L. DISEASE. - EA EMPLOYEE $ If ea, desm"s under D OF OPERATIONS below EL. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Rornarks Sohedule, K more space Is requIred The City of Clearwater is an additional insured as per the Commercial auto policy with a waiver of subrogation in favor of the additional insured. 30 days notice of cancellation. City of Clearwater Attention: City Clerk PO Box 4748 Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FL 33758748 AUTHORIZED REPRESENTATIVE Fax: ( ) - O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD_26(701010 The ACORb name aria logo are regff rred rks of ACORD `?