CERTIFICATE OF LIABILITY INSURANCE (171)CERTIFICATE OF LIA
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONU
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUi
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the
the terms and conditions of the policy, certain policies may require an e
certificate holder in lieu of such endorsement(s)-
PRODUCER
Aon Risk services South, Inc.
Franklin TN Office
501 Corporate Centre Drive
Suite 300
Franklin TN 37067 USA
INSURED
Malcolm Pirnie, Inc.
44 S. Broadway
15th & 16th Floors
white Plains NY 10602 USA
Y)
DATE(MM/
2011
BILITY INSURANCE osrzarol
' AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
E A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
Indorsement A statement on this certificate does not confer rights to the
CONTACT
NAME:
PHONE (NC.No.Ext; (866) 283-7122 ? No.: (847) 953-5390
E4MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: Lexington insurance company 19437
INSURER B:
INSURER C:
INSURER D:
INSURER E:
INSURER F:
MBER•
OVERAGES CERTIFICATE NUMbtK: 07UU4GD79105 REVISION NU
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. Limits shown are as request6
rR TYPE OF INSURANCE INSR WVD POLICY NUMBER p ILWLICY LIMBS
GENERAL LIABILITY EACH OCCURRENCE
COMMERCIAL GENERAL LIABILITY PREMISES Ea currence
CLAIMS-MADE ? OCCUR MED EXP (Any one person)
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRo- LOC
JECT
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED ??? O?
AUTOS B AUTOS
HIRED AUTOS NON-OWNED
UMBRELLA UR
EXC SS AB CLAIMS-MADE I I I YLEGAJI.r7„ `E
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR! PARTNER 1 EXECUTIVE
OFFICERIMEMBER EXCLUDED? N/A
(Mandatory In NN)
If Yes, describe under
DEPT
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
BODILY INJURY ( Par person)
BODILY INJURY (Per accident) ::J
PROPERTY DAMAGE
EACH OCCURRENCE
AGGREGATE
E.L. EACH ACCIDENT
E.L. DISEASE-EA EMPLOYEE
E.L. DISEASE-POLICY LIMIT
A Archit&Eng Prof I U154409vu E."al /vi/coil h liProf & Poll Liab I Annual Aggregate $1,000,(
SIR applies per policy ter & tondi}lions
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101. Additional Remarks Schedule, It more space Is required)
Re: All Operations of the Named Insured. For Professional Liability coverage, the Aggregate Limit is the total insurance
available for claims presented within the policy period for all operations of the insured. The Limit will be reduced by
payments of indemnity and expense.
Cancellation Provision shown herein is subject to shorter or longer time periods depending on the jurisdiction of, and reason
for, the cancellation.
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CERTIFICATE HOLDER CANCELLATION W-A
City of Clearwater
Attn: city clerk
P.O. Box 5748
Clearwater FL 33758 USA
SHOULD ANY OF THE ASOvE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS-
AUTHORIMD REPRESENTATIVE
JgC e?iLb? V 1, L
®1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
Attachment to ACORD Certificate for Malcolm Pirnie, Inc.
The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage
afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the policy.
INSURED
Malcolm Pirnie, Inc.
44 S. Broadway
15th & 16th F=loors
white Plains NY 10602 USA
ADDITIONAL POLICIES
INSURER
INSURER
INSURER
INSURER
INSURER
If a policy below does not include limit information, refer to the corresponding policy on the ACORD
certificate form for policy limits.
INSR
LTR
TYPE OF INSURANCE ADDL
INSR SUBR
wVD POLICY NUMBER/
POLICY DESCRIPTION POLICY EFF
(MMIDWYYYY) POLICY EXP
(MMIDD/YYM
LIMITS
OTHER
X Claims-Made
X Professional Liabil
X and Contractors
IX Pollution Liability
Certificate No : 570042675105