CERTIFICATE OF LIABILITY INSURANCE (115)ACORDM CERTIFICATE OF LIABILITY INSURANCE osii;�z"oi'
PRODUCER g52. 653.1000 � FAX 95Z. 653.1101 THIS CERTIFICATE IS ISSUED AS A MATf'ER OF INFORMATION
Christensen Group ONLY AND CONFERS NO F21GHT5 UPON THE CERTIFICATE
InSUranCe Resources int' 1. HQLUER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDEl7 BY THE POLICIES BELOW.
11100 Bren Raad West
Minnetonka, MN 55343 INSURERS AFFORDING COVERAG� NAIC #
IN5l1R�D CERES ENVIRONMENTAL SERVICES� INC. INSURERA: Si2d(Ifc7St Ifi$!I►'c7fl[2 Company
6960 Prafessional Pkwy East iNSU�Rg: Zurich American Ins. Co.
Sarasota, FL 34240 INSURER C:
INSURER D:
INSURER E: �
CO G
THE PQLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TME INSURED NAMED ABQVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CON�ITION �F ANY CDNTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE PQLICIES DESCRIBED HEREIN IS SUBJECT T� AI,L 1'HE YERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POUCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUC�D BY PAI� CI.AIMS.
INSR DD' Typ� pF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
�eNpru�. �iasiurr BOG9313048-00 08/18/2011 OS/l8/2012 �CH OCCURRENCE s 1, 000, 00
X CQMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 1 DO� OO
ClAIMS MA�E � OCCUR MED EXF' (My one person) $ 5� QO
,Q - PERSONAL & ApV INJURY S j� QQO � OO
GENERAL AGGREGATE $ Z� OOO � OO
GEN'I, AGGREGATE LIMIT APPLIES PER: PRODUC7S - COMP/OP AGG $ ,Z � QOO, OU
POLICY x j� � LOC �
AUTOM081LE LIA8ILITY BAP9313049-00 �8�18�2�11 �S�ZS�20�z CQMBINED SINGLE LIMIT $
X ANYAUTO P,:�� (EaaCCident) 2�000�00
ALL ONRJED AUTOS N �� -'. " i:��
���`Y BO�ILYINJURY $
8 $GHEDULED AUTOS (Per peBan)
WIREDAUTOS Sr^• �� � Q�1
1 80DILY INJURY
NON-OWNED AUTOS `� � (Per accldent) $
'm,/' ��ICIt-. ' '....Ly ���""' (Per�eccident)AMAGE $
GARAGE LIABILITY ••- °••-� ="'�' AUTO ONLY, EA ACCI�ENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSIUMBRELLA LIA8ILITY SE0926627801 OS�IS�Z011 OS�ZS��ZU�Z EACH DCCl1RRENCE $ j� OOO� OO
X OCCUR � CLAIMS MADE AGGREGATE S 1� OOO� OO
A $
pEDUCTIBLE $
RETENTIpN $ $
WORKBRS COMPENSATION AND WC9313050-00 OS�I$�Z011 OS�IS�ZOl� X � STATU- OTH-
EMPLOYER5' LIABILITY � .. O�Q }
- �� --�.— ,_.._..._.._ . ,. _. E.L. EACH ACCIDEN7 $
OFFICERMIEMBER EXGLU�E�7 E.L. �ISEASE - EA EMPLOYE $ 1, OOO� OO
IF yes, describe under
SPECIAL PROVISIONS bBlow E.L OISEASE - POLICY LIMIT $ Y� OOO� OO
oTF+ BOG9313048-00 OS/18/2011 08/18/2012 $1Mi7 - Ea�h Condition/C1aim
ro�essional Liability
A ontractors Po7lution PEC9166286-01 OS/18/2011 08/18/ZOl2 $1Mi1 - Each tondition/C1aim
CESCRIPTION OF O ERAT10N5 / LOCATIO S f YEHIC E5l EXC4 19N5 AbOED BY EN�pRSEMENT / SPECIAL PROVISIONS
he City o�C7earwater ��ste� as a� it�onal insured
� 10 Days Cancellation far non-payment, 30 days for a17 other valid reasons*
City of Clearwater
RFP 25-11
Attn: City C1erk
P.O, eax 474$
Clearwater, FL 33758-4748
SHOUL� ANY OF THE ABpVE DESGRIBE� POLICIES 8E CANCELLED BEFORE THE
EXPIRATION pATE THEREOF, THE ISSUING INSURER WILL EN�EAVOR TO MAIL
'�3O �AYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMEp TO THE LEF7,
BUT FAILl1RE TO MAIL SUCH NOTICE SHALL IMPOSE NO 061,IGATIpN OR LIABILI7Y
OF ANY KIND UPON THE INS
AUTHORI2E0 REPRESENTATIVE
ITS AGENTS OR REPRESENTATIVES.
. . _ � I Tyl er Simmons/KP , /' ;�""^`�"~� �
AGPRp �� f �PV�IV81 - _ O�GDRD GORPORATION �988
IMPORTANT
If the certificate holder is an ADDITIONAL INSUR�D, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
7he CeRificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor daes it
affirmatively or negatively amend, extend or alter the coverage affarded by the policies listed thereon.