CERTIFICATE OF LIABILITY INSURANCE (176)Client#: 584486 LEGGEBRA
ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
6/16/2011
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 CONTAu
NAME:
USI Ins. Services of CT, Inc. aHONN E1111:203 634-5700 A/C No : 2036345701
530 Preston Avenue E-MAIL
Meriden, CT 06450 ADDRESS:
- •-°--
203 634-5700 7= 113 M
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A: Hartford Fire Insurance Co 19682
et ors & Graham, Inc. INSURER B: Hartford Casualty Insurance Com 29424
4 Research Drive
Suite 301 INSURER C: Hartford Accident & Indemnity C 22357
Shelton, CT 06484 INSURER D: Chartis Specialty Insurance Corn 26883
•- ?-
INSURER 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.
NSR TYPE OF INSURANCE DDL UBR POLICY EFF POLICY EXP
-T NS VVvD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS
A GENERAL LIABILITY 31UUNZK6256 11/01/2010 11/01/2011 EACH OCCURRENCE $1 001000
X COMMERCIAL GENERAL LIABILITY PDAMAGE TO RENT -
REMISES Ea occurrence $300,000
? OCCUR MED EXP (Any one person) $10,000
tCCLAIMS-MADE
ntractual PERSONAL&ADVINJURY $1,000,000
,U included GENERAL AGGREGATE $3,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $3,000,000
RO-- F LOC $
POLICY f 7 P
JECT
B I AUTOMOBILE LIABILITY 131
ALL OWNED AUTOS
SCHEDULEDAUTO$ JUN 2 2
HIRED AUTOS
NON-OWNED AUTOS G1 F 9CAL REG
/01/2010111/01/201
AND
COMBINED SINGLE LIMIT $
(Ea accident) 1
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
(Per accident)
$
B X UMBRELLALIAB X OCCUR 31XHUFC0726
t ESS LIgB CLAIMS-MgpE
UCTIBLE
ENTION $ 10000
C WORKERS COMPENSATION 31 WENJ0522
AND EMPLOYERS' LIABILITY Y I N OFFICERIMEMBER EXCLUDEp7 ECUTIVE® N/A
(Mandatory In NH)
If yes, describe under
uESUHIP I IUN OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1
D Pollution/Profess OPS3778313 6/17/2011 06/17/201 $5,000,000/$5,000,000
Liab claims made DIED $50,000 -I r DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule. If more space Is required)
City of Clearwater is named as Additional Insured with respects to the above General Liability and
Automobile policies when required by written contract in accordance in policy terms, conditions and
exclusion.
1101/2010 11/01/2011 EACH OCCURRENCE $1
AGGREGATE $1
$
1/01/2010
11/01/2011
X WC Tmur
IER OTH- $
E.L.EACH ACCIDENT $1
E.L. DISEASE - EA EMPLOYEE $1
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.
Attn: City Clerk
100 S. Myrtle Ave. AUTHORIZED REPRESENTATIVE
CLEARWATER, FL 33758-4748
®1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 Of 1 The ACORD name and logo are registered marks of ACORD
#S6116698/M6114719 SXAZP
}USI Ins. Services of CT, Inc.
530 Preston Avenue
Meriden, CT 06450
203 634-5700
City of Clearwater
Attn: City Clerk
100 S MYRTLE AVE
CLEARWATER FL 33756-5520
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