CERTIFICATE OF LIABILITY INSURANCE (173)f'Iinn+A- sling
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ACORDTM CERTIFICATE OF LIABILITY INSURANCE (M
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02/201
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: I the certificate holder is an ADDITIONAL INSURED, the pollcy(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 endorsement(s).
PRODUCER CONTACT
NAME:
ISU Suncoast Insurance Assoc PHONENo E.t 813 (All, No): 8132894561
A/C
P.O. Box 22668 E-MAIL
ADDRESS:
Tampa, FL 33622-2668 'rKUUUUrK
CUSTOMER ID
813 289-5200
INSURER(S) AFFORDING COVERAGE NAIC #
_
INSURED mT INSURER A: Phoenix Insurance Company 25623
Grimail Crawford, Inc. INSURER B : Travelers Casualty and Surety C 19038
1511 N Westshore Blvd INSURER c : Everest National Insurance Comp 10120
Suite 1115
INSURER D :
Tampa, FL 33607
INSURER E
INSURER F :
r'nVG17Ar1CC f'FRTIGIr_ATF NIIMRFR- RFVIRION NIIMRFR-
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.
NSR
TYPE OF INSURANCE
DDL
NS
UBR
D
POLICY NUMBER
POLICY EFF
MM/DD
POLICY EXP
MM/DD/YYYY
LIMITS
A GENERAL LIABILITY 680528OL540 10/14/2010 10/14/2011 EACH OCCURRENCE s2,000,000
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $1,000,000
CLAIMS-MADE 51OCCUR MED EXP (Any one person) $10,000
PERSONAL & ADV INJURY $2,000,000
GENERAL AGGREGATE $4,00_0,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $4,000,000
POLICY PRO- LOC N T $
A AUT OMOBILE LIABILITY BA220M6366 11/3012010 11/30/2011 COMBINED SINGLE LIMIT
E
id $
(
a acc
ent) 1,000,000
ANY AUTO
BODILY INJURY (Per person) $
r ALL OWNED AUTOS BODILY INJURY (Per accident) $
SCHEDULED AUTOS PROPERTY DAMAGE
XX HIRED AUTOS (Per accident)
$
$
X NON-OWNED AUTOS
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
- -EXCE?„
CLAIMS-MADE
-----.?J-
-------
----.._.._ -
-AGGREGATE "._?_ ?.-
--$ _
DEDUCTIBLE $
RETENTION $
B WORKERS COMPENSATION
' UB6100Y759 5/2212011 05122/201 X WC STATU- OTH-
IER
AND EMPLOYERS
LIABILITY
Y/ N
ANY PROPRIETOR/PARTNER/EXECUTIVE F1, EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) N/A
E.L. DISEASE - EA EMPLOYEE
$1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE- POLICY LIMIT
$1,000,000
C Professional 79AE00041311 5/29/2011 05/29/201 $2,000,000 per claim
Liability $2,000,000 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.
RE: City of Clearwater Engineering of Record
RFCFIVR?
trCK I IF11..A 1 C r1ULUCK VAIV I?CLLA I IUIY
City of Clearwater JUN 0 6 2011 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Engineering Dept. Ste. 200 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Susan Chase LEGISLATIVE R WRDSS ?
PO Box 4748 LEGISLATIVE S O S DEI UTHORIZED REPRESENTATIVE
Clearwater, FL 33758-4748
0 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S321595/M321588 MRL