CERTIFICATE OF LIABILITY INSURANCE (175)r`linnl$• 97AQ
PLISARC3
1 1YY)
ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE
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 endorsement(s).
PRODUCER NCONTACT
AME:
ISU Suncoast Insurance Assoc PHONE 813 289-5200 ac, No :8732894561
AIC N. Ext
P.O. Box 22668 E-MAIL
ADDRESS:
Tampa, FL 33622-2668 50
CUSTOMER ID #:
813 289.5200 INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A: Phoenix Insurance Company 25623
Plisko Architecture, P.A., AIA INSURER B : Travelers Casualty and Surety C 19038
800 Drew St INSURER C : XL Specialty Insurance Company 37885
Clearwater, FL 33755
INSURER D
INSURER E :
INSURER F :
r.vv?ner_?e _ .r•C01r10Ir11&TA All I&AMr-0• RI-VI'ILIN NLIMIYCK:
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.
LTR TYPE OF INSURANCE
Ng
POLICY NUMBER POLICY EFF
MM/DD/YYYY POLICY EXP
(MM/DDIYYYY) LIMITS
A GENERAL LIABILITY 6602432R749 6/18/2011 06/18/201 EACH OCCURRENCE $110001000
X
COMMERCIAL GENERAL LIABILITY DAMA
PREMISES Ea occurrence
$1,000,000
CLAIMS-MADE Fx_1OCCUR MED EXP (Any one person) $10,000
PERSONAL & ADV INJURY $11,000,000
GENERAL AGGREGATE $2,000,000
GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
POLICY FITT- F-1.11 LOC _ $
A AUT OMOBILE LIABILITY 66024321R749 06/18/2011 06/18/201 COMBINED SINGLE LIMIT
(Ea accident) $
1
000
000
ANY AUTO RECEP/E BODILY INJURY (Per person) ,
,
$
ALL OWNED AUTOS L?U? \\\ II'' BODILY INJURY (Per accident) $
SCHEDULED AUTOS PROPERTY DAMAGE
X
HIRED AUTOS ???O?
(Per accident) $
X NON-OWNED AUTOS
q
0,- IC
$
UMBRELLA LIAR OCCUR LEGISIQ?wn vzf`CS DIF EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
B WORKERS COMPENSATION UB7080Y545 9/01/2010 09/0112011 X WCSTATU- 07H-
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVEYIN
E.L. EACH ACCIDENT
$100,000
OFFICERIMEMBER EXCLUDED? 7y
(Mandatory In NH) NIA
E.L. DISEASE - EA EMPLOYEE
$100,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$500,000
C Professional
Liability DPR9686629 9/11/2010 09/1112011 $1,000,000 per claim
$1,000,000 annl a r.
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
Professional Liability coverage is written on a claims-made and reported basis.
HOLDER
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.
PO Box 4748
Clearwater, FL 33758.4748 AUTHORIZED REPRESENTATIVE
OL9:® 1-ft 0&-W-- /?
01988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S324030/M324029 MRL