CERTIFICATE OF LIABILITY INSURANCE (182)Client#: 2749 PL.ISARC3
acoR� CERTIFICATE OF LIABILITY INSURANCE Dp9/012011YY'
THIS C�RTIFICATE IS ISSUED AS A MATTER OF IN�QFiMATION ONLY AND CONFERS NO RIGWTS UPON THE CERTIFICATE I10LDER. THIS
CERTIFICATE DO�S NOT A�FIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR AI.T�R iHE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT B�TWEEN 7HE ISSUING INSURER(S), AUTHORIZED
REPRESEN7'ATIVE OR PRODUCER, AND THE CERTIFICAT� HQLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must ba �ndorsed. If SUBROGATI�N IS WAIVED, subJect to
the terms and conditions of the policy, certain policles may require an endorsement. A statement on this oertificate does not confer rights to the
c�rtificate holder in lieu of such endorsement(s).
PHODUCER NAME:
ISU Suncoast Insurance Assoc PW�NE 813 288-5200 a�, Np : 813-289-4561
ac No ex� :
P.O. Box 22668 ADDRESS:
Tampa, FL 33622-2668
CUSTOMER IP S:
81$ 289-5200
VERAGE NAIC �k
INSURED
Plisko Architecture, P.A., AIA
800 Drew St
Clearwater, FL 33755
INSl1RER(S) AFFORDING CO
iNSUAeRa: Phoenix Insurance Company 25623
�NSUpep s: Travelers Casualty and Surety C 19038
�NSUReR c: XL Specialty Insurance Company 37885
iNSUR�R � :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
TMIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN IS5UED TO THE INSURED NAMED ABOVE FOR THE POIICY PERIOD
INDICA7Ep. NQTWITHSTANDING ANY REQUIREMENT, TERM OR CONDI710N OF ANY CONTRACT OR OTHEFi DOCUMENT WITH RESPECT TO WHICH 7HIS
CERTIFICATE MAY BE 15SUEp OR MAY PERTAIN, THE INSURANCE AFFORDED BY 7NE POI.ICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLIGIES. LIMITS SHOWN MAY MAVE BEEN REbUC�D BY PAID CLAIMS.
IN R TypE OF INSURANCE pOI.ICY NUM9ER pAANWD/YYYY MM%OYWI�IYYY LIMITS
TR
A GENERAL LIA9ILITY 6602432R749 06/18/2011 06/1 S/201 EACH OCCURRENCE $1 ��0 ���
X COMMERCIAL GENERAL LIAeILI7Y PREM SES Ea occurcence S� ,000�OOO
CLAIMS-MA�E � OCCLIR ME� EXP (Any one person) $10����
PERSONAL & AOV INJURY $1 �OOO�OOO
GENERAL AGGR�GATE $Z�OOO�OOO
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $Z�OOO�OOO
POLIGY PR� LOC �
A AUTOMOBILE LIABILITY 6602432R749 6/18/2011 06/18/201 COMBINED SINGLE LIMI7
(Ea accidenq $1 ��0 ��0
ANY AUTD . BqDILY INJURY (Per parson) $
ALL OWNED AUTOS gO�ILY INJURY (Per accident) $
5CHEDULED AUTOS PRpPERTY DAMAGE
X HIREp AUTOS
(Per aCCident) $
$
X NON-OWNED AUTOS ..w„
$
UM6RELLA LIAB OCCUR EACH OCCURRENCE $ �
EXCESS LIAB CLAIMS-MADE AGGREGATE $
bEdUCTIBLE $ —_.
.�_�_ RETENTION � . --_.,.--._. �_..,...� �... $
� WORKERS COMPEN5ATIGN �JB708�Y�rj 9/01J2011 09/01/201 X WC STATU- OTH-
ANU EMPLQYERS' LIABIL(TY �
ANV PROPRIETOR/PARTNER/EXECU7IVEY❑ � E.L. EACH ACCIDENT $1 OO�OOO
OFFICER/MEMBER EXCLUPE47 WA
(Mandalory In NH) E-1.- PISEASE - EA EMPLOYEE $1 OO�OOO W
If yes, describa under
DESCRIPTIpN DF dPERATIONS below E.L. PISEASE - POLICY LIMI7 $�OO�OOO
C Professional DPR9fi86629 Q9/11/2010 09/11/2011 $1,00O,OOU per claim
Liabili $1,000,000 annl a r.
DESCRIPTION OF pPERATIQNS f LOCATIONS ! VEHICLES (Attaeh ACOR� 1D7, Additfonal Remarks Sehedule, li more spece is requlred)
Professional Liability is written �n a Claims Made and Reported Basis.
����"��,�.�,�`�
SEP 0 � � ����
City of Clearwater
Attn: City Clerk �� ..d��� ���� ..:��� �,��
PO Box 4i48 ����r��^�� �y V'�� �,��+'
Clearwater, FL 33758-4748
SHOULD ANY OF THE ABbVE DESCHIBED POLICIES BE CANCELLED B�FORH
THE EXPIRATION �ATE THEREOF, NOTICE WILL 8E DELIVERED IN
ACCORDANCE WITH THE PQLICY PROVISIONS.
AUTMORIZED REPRESENTATIVE
pL� � Q�..-c� .��•�--�
� 1988-2009 AGORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 of 1 The ACORb name and logo ar� registered marks of ACORD
#5338117/M338116 KIM