CERTIFICATE OF LIABILITY INSURANCE (5) Client#: 3970 JONEEDM3
A CORDTM CERTIFICATE O F LIABILITY INSURANCE DATE(MM/DD/YYYY)
06/30/2011
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
NAME:
ISU Suncoast Insurance Assoc PHONE 813 289-5200 FAX 8132894561
A/C,No,Ext: (A/C,No):
P.O. Box 22668 E-MAIL
ADDRESS:
Tampa, FL 33622-2668 PRODUCER
CUSTOMER ID#:
813 289-5200
INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURERA:Travelers Indemnity Company of 25682
Jones Edmunds&Associates, Inc. INSURER B:Travelers Indemnity Company 25658
730 N.E.Waldo Road INSURER C: Y Libert Mutual Ins Co
Gainesville, FL 32641 INSURER D:XL Specialty Insurance Company 37885
INSURER E:Travelers Property Cas Co of Am 25674
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 TYPE OF INSURANCE DDL UBR POLICY EFF POLICY EXP LIMITS
LTR NSR D POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
A GENERAL LIABILITY 68019511_902 06/30/2011 06/30/2012 EACH OCCURRENCE $1,000,000
DAMAGE To RENTED
X COMMERCIAL GENERAL LIABILITY 'REM SES(E.occurrence) $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
POLICY PRO- LOC $
E AUTOMOBILE LIABILITY BA19581_731 06/30/2011 06/30/2012 COMBINED SINGLE LIMIT
(Ea accident) $1 000 000
X ANY AUTO BODILY INJURY(Per person) $
ALL OWNED AUTOS BODILY INJURY(Per accident) $
SCHEDULED AUTOS
PROPERTY DAMAGE $
X HIRED AUTOS (Per accident)
X NON-OWNED AUTOS $
B X UMBRELLA LAB X OCCUR CUP6513Y228 06/30/2011 06/30/2012 EACH OCCURRENCE $5,000,000
EXCESS LAB CLAIMS-MADE AGGREGATE $5,000,000
DEDUCTIBLE $
X RETENTION $ 10,000 $
C WORKERS COMPENSATION WCJZ91454854 06/30/2011 06/30/201 X WC STATU- OTH-
AND EMPLOYERS'LIABILITY TORY LIMITS ER
Y
ANY PROPRIETOR/PARTNER/EXECUTIVEâť‘ E.L.EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) 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 DPR9694461 06/30/2011 06/30/2012 $5,000,000 per claim
Liability $5,000,000 annl aggr.
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.
CERTIFICATE HOLDER CANCELLATION
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
0 - 06--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
#S326395/M 326379 M RL