CERTIFICATE OF LIABILITY INSURANCE (4)Clipnt#- 3970
IONEEDM3
ACORD,M CERTIFICATE OF LIABILITY INSURANCE E
(M
MIDD
)
F D
/
O
01
06
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 NCONTACT
AME:
ISU Suncoast Insurance Assoc PHONE $13 2$9.5200 FAX No ; 8132 894561
A/C No Ext
P.O. Box 22668 tz-MAIL
ADDRESS:
Tampa, FL 33622.2668
cusroMER ID #:
813 289-5200
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED fsT INSURER A: Travelers Indemnity Company of 25682
Jones Edmunds & Associates, Inc. INSURER B : Travelers Indemnity Company 2565.8__
730 N.E. Waldo Road INSURER C : LibertyMutual Ins Co
Gainesville, FL 32641 INSURER D: XL Specialty Insurance Company 37885
INSURER E : Travelers Property Cas Co of Am 25674
INSURER F: I
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 TYPE OF INSURANCE D
NSR BR
D
POLICY NUMBER POLICY EFF
(MM/DDIYYYY) POLICY EXP
MM/DD/YYYY
LIMITS
A GENERAL LIABILITY 68019511-902 06/30/2011 06/30/201 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO Ft
REMISES Ea oeau ante
P
$1,000,000
CLAIMS-MADE FxI OCCUR MED EXP (Any one person) $10,000
PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
F_] JFCT F7 PRO LOC
POLICY
ph R-
$
E AUT OMOBILE LIABILITY BA19581-731 0 6/30/207
0 COMBINED SINGLE LIMIT
Ea accident) $
14 4 ( 1,000,000
X ANY AUTO
BODILY INJURY (Per person) $
ALL OWNED AUTOS JUL 05 2? v BODILY INJURY (Per accident) $
SCHEDULED AUTOS 1
PROPERTY DAMAGE
$
X HIRED AUTOS
)
(Per accident
,y
?yt
X NONOWNED AUTOS 4?;
n
4
$
B X UMBRELLA LIAR X OCCUR UP6513Y228 /2011 06/30/201 EACH OCCURRENCE s5,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE 1$5,000,000
DEDUCTIBLE $
RETENTION $
C WORKERS COMPENSATION
' WCJZ91454854 6/30/2011 06/301201 X WC STATU- OTH-
LIABILITY
AND EMPLOYERS
Y
1
000
000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT ,
,
$
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) N/A
E.L. DISEASE - EA EMPLOYEE
$1,000,0_00_
If yes. describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE- POLICY LIMIT
$1,000,000
D Professional DPR9694461 06/30/2011 06/30/201 $5,000,000 per claim
Liabili $5,000,000 anni 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.
Project: 2009 Engineer of Record
City of Clearwater Is listed as additional insured with respect to the General and Auto Liability policies.
I E HULUtK
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
CIZ. eft 06-Gi- A O--- -
091988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S326395/M326379 MRL