CERTIFICATE OF LIABILITY INSURANCE (181)Client#: 3206 AUDEROB3
ACORD.� CERTIFICATE OF LIABILITY INSURANCE o07/22l201�1 '
7HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
C�RTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIV�LY AMEND, EXTEND OR AL7ER THE COVERAGE AFFORDED BY THE POL.ICIES
BELOW. THIS CERTIFIGATE OF INSURANCE DOES NOT C�NSTITUT� A CONTRACT BETWE�N THE 135UING INSURER(S), AU7HORIZED
REPRESENTA7IVE OR PRODUC�R, AND 7ME CERTIFICATE MOLDER.
IMPORTANT: If the certificata holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subJ�ct ta
the terms and conditions of the policy, certain policies may requlre an endorsement. A statement on this certiflcate does not confer rights to the
certlficat� holder in lieu of such endorsement(s).
PRObUCER �E:
(SU Suncoast Insurance Assoc PHONE g13 289-5200 ac N, : 813 289-4561
A/C Np Ext :
P.O. Box 22668
�
ADDRE5S:
Tampa, FL 33622-2668 -
CUSTOMER ID #:
813 289�rJ2OO INSURER(S) AFFORDING COVERAGE NAIC, #
iNSURen iNSUaea a• Old Dominion Insurance Company 40231
Robert Aude Associates Inc AIA
The Brentwood Studio
1719 Brentwood Dr
Clearwater, FL 33756
iNSUReR e: Travelers Casualty & Surety Co 19038
iNSUReR c: XL Specialty Insurance Gompany 37$85
INSl1RER D :
INSURER E :
COVERAGES CERTIFICATE NUMB�R: REVI510N NUMBER:
7HI5 IS TO CERTIFY THA7 TNE POLICIE5 OF INSUFiANCE LISTED BELOW HAVE BEEN 15SUE�D TQ THE INSURED NAMEd AB�VE FQR THE POLICY PERI�D
INDICATED. NOTWITH3TAN�ING ANY REQUIREMENT, TERM aR CONDITION OF ANY CONTFtACT QR OTHER DOCUMENT WI7H RESPECT TO WHICH THIS
CERTIFICATE MAY B� ISSUED OR MAY t'ERTAIN, THE INSURANCE AFFaRpEp BY THE POLICIES DESCRIBED M�REIN IS SUBJECT TO ALL THE 7ERMS,
F�CCLUSIONS AND CONDITIONS OF SUCH P�LICIES. LIMITS SHOWN MAY HAVE BE�N REDUCED BY PAI� CLAIMS.
TYPE OF IN5URANCE R POLICY EFF POLICY FJ(P
TR N � POLICY NUMBER MMIDD MM/DD/YYYY ��M�T$
A GENERAL LIABILJTY BpG98�417 7/22/2011 07/22/201 EACH OCCURRENCE $� OQQ Q�0
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occu �nce S�JOO,000. .
CLAIMS-MADE � OCCUR MED EXP (My one person) $�J,OOO
� � � � � . . PERSONAL 8 A�V INJURY 5� ��OQ0��0�
GENERALAGGREGATE $Z�OOO�OOO.
GEN'L AGGREGATE LIMIT APF'LIES PER: PRO�UC73 - COMP/OP AGG $Z�OOO�OOO
POLICY p�� LOC $
A AUTOMOBILE LU1BILffY BPG9841 y 712�/2011 O7I22/201 COM8INED SINGLE LIMIT $
. (Ea eccident) 7 000 000
ANY AUTO � BO�I�Y INJURY (Per person) $
ALL OWNE� AUT�S
BODILY INJURY (Per eccident) $
SCHEDUIEp AUTOS PROPERTY DAMAGE
$
X HIRED AUTOS
(Peracadent)
X NON-OWNE�AUTOS
$
S
A X UMBRELLA LIAB X occuR CUG98417 7/22/2011 07/22/2D1 EACM OCCURRENCE s1 000 p00
FJCCE$S UAe __.. . C�lMS-MAPE - _ AGG EGATE . _ . . _ $.� OOO DOO .._ _ . ..
OEDUCTIBLE $
RETENTI�N $
B WORKERS COMPENSATION U B7080Y385 9/01 /2011 09/01 /201 X WC STATU- OTH-
AND EMPLqYER3' LIA8ILITV
ANY PROPRIE7pR/PARTNERlEXECUTIVEY� E.L. EACH ACCIPENT $rJOO�OQO
OFFICERlMEMBER EXCLU�ED? WA
(Mandatory In NH) E.L. DISEASE - E4 EMPLOYEE $J�0�0��
IfyBs de5Cri6e under
DESCRIPTION OF OPERATION$ below E.L. DISEASE - POLICY LIMI7 $rJOO,OOO
C Professional DPR9B94687 7/20/2011 07/20/207 $50D,000 per clalm
l.iabili $500,000 annl a r.
DESCR1PT14N OF OPERATIONS / 40CATONB f VEHICLES (Attach ACpIiD 101, Addltlonal Remarka Schedule, lf more space is requlred)
Professional Liability coverage is written on a claims-made and reported basis.
City of Glearwater is an additional insured w/respect to General Llability
(See Attached Descriptlons)
CERTIFIGA7E HOLDER _ ' ' CANCELLATION
Gity af Clearwater % SHOULD ANY OF 7H� ABQVE DESCRIBED POLICIES BE CANCELLED B�FORE
Attn: City Clerk ,�u�, � e '"��� ACCORdANCE WITH THE POLICY PROVISI�NI$L B� bELIVERED IN
P.O. Box 4748 ryC
Clearwater, FL 33758-474$ wy,,: -;`;�/� V��
�u" ���� AUTHORIZEO REPRESENTATIVE
o ������ �:iV°� ���;
OL� � Q�.�� �•�'-"�
�9�ySts-[VUy �vt,.urcv t,.urcrvruai ivrv. rau ngnr,s reaerveu.
ACORD 25 (2d09/09) 1 of 2 The ACORD name and Iqgo are registered marks of ACORD
#S331307/M331296 K��
AMS 25.3 (20�9l09) 2 of 2
#5331307/M331296