CERTIFICATE OF LIABILITY INSURANCE (177)Client#: 2962
SDIENVI3
ACORDTM CERTIFICATE OF LIABILITY INSURANCE
1 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(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 CONTACT
NAME:
ISU Suncoast Insurance Assoc A/C, No Et): 813 289.5200 MC No ; 8132894561
P.O. Box 22668 h-MAIL
ADDRESS:
Tampa, FL 33622-2668
CUSTOMER Ib #:
813 289-5200 INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A: Phoenix Insurance Company 25623
S D I Environmental Services, Inc. Travelers Indemnity Company
INSURER a : 25658
3903 Premier North Drive _
INSURER C : Travelers Casualty and Surety C 19038
Tampa, FL 33618 INSURER D : American Safety Indemnity Compa 25433
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 TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
L
TYPE OF INSURANCE ADDL
Ng
p
POLICY NUMBER _ POLICY EFF
(MM/DDfYYYY) POLICY EXP
MM/DD/YYYY
LIMITS
A GENERAL LIABILITY 680196OL23A 06/30/2011 06130/201 EACH OCCURRENCE $1,000 000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
REMISES Ea occurrence
P
$1,000,000
CLAIMS-MADE FxIOCCUR MED EXP (Any one person) $10,000
PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE 52,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
POLICY PRO LOC $
B AUT OMOBILE LIABILITY BA25621-1
EC ?/ 2912010 07/29/2011 COMBINED SINGLE LIMIT $
' 7 (Ea accident) 1 000 000
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED AUTOS
JUN 2 BODILY INJURY (Per accident) $
X SCHEDULED AUTOS
HIRED AUTOS 4 201 PROPERTY DAMAGE
(Peraccident)
$
X NON-OWNED AUTOS ?'`q ?. AC11AL RECORD BN
L-, $
LEI I , i •? efsE. `v $
B X UMBRELLA LIAR OCCUR CUP6416Y164 6/3 /2011 06/30/201 EACH OCCURRENCE $1,000,000
EXCESS LIAR CLAIMS-MADE AGGREGATE $1,000,000
DEDUCTIBLE $
C WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY UB7082Y944 9/01/2010 09/0112011 X WCSTATU- OTH-
118
ANY PROPRIETOR/PARTNER/EXECUTIVE -N E.L- EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? N
(Mandatory In NH) NIA
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
Liability ENV0106241006 9/02/2010 09/02/2011 $1,000,000 per claim
$1,000,000 annl a r.
DESCRIPTION OF OPERATIONS I 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.
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
Y ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 4748
Clearwater, FL 33758.4748 AUTHORIZED REPRESENTATIVE
OLD "t. 06--W- Aa -
A 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S325088/M325084 MRL