CERTIFICATE OF LIABILITY INSURANCE (185)Client#: Z749 PLISARC3
ACORD,� CERTIFICATE OF LIABILITY INSURANCE °og,a;;201"�""'
THIS CERTIFICATE IS ISSUED AS A MAITER OF INFURMATION ONLY AND CONF�RS NO RIGWTS UPON TME CERTIFICAT� N�LDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR AL7ER THE COV�RAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANGE DOES NOT CONSTITUTE A CONTRACT BE7WEEN TME ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificat� holder is an ADDI710NAL INSUREb, the pollcy(ies) must b� endorsed. If SUBROGATION IS WAIVED, subject to
th� terms and conditions of the policy, certaln policies may require an endors�ment. A statement on this c�rtificate does not confer rights to the
c�rtificate halder In Ileu of such �ndorsement(s).
PROOUCER NAME:
ISU Suncoast Insurance Assoc PHONE g13 289-5200 a� Na ; 8132894561
AIC No Ext :
P.O. Box 22668 �p��:
Tampa, FL 3362�-2fi68
cusTaMea ro a:
813 289�rJ20� INSURER�3) AFFDRPING COVERAGE NAIC #
INSURED
Plisko Architecture, P.A., AIA
80� Drew St
Clearwater, FL 33755
iNSUReRa: �'hoenix Insurance Company 25623
iNSUReR s: Travelers Casualty and Surety C 19Q38
iNSUReR c: 7CL Specialty Insurance Company 37885
iNSUReR e :
INS RER F :
COVERAGES CERTIFICATE NUMBER: REVISI�N NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW FIAVE BEEN ISSUED TQ THE INSURED NAMHD ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACi OR QTHER DOCUMENT WITH RESPEC7 70 WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, 7HE INSURANCE AFFORDED BY THE POI.ICIES DESCRIBED MEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AN� CONDITIONS OF Sl1CH POLICIES. LIMIT$ $HOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
� TYPE OF IN3URANCE DDL UB POLICY EFF PP ICY EXP LIMITS
� p POLICV NIIMeER MM/DD/YYYY MM/DD
A GENERAL LIAF31LI7Y 6602432R749 06/18/2011 06/18/201 EACH OCCURRHNGE $� 0�0 Q��
X COMMERCIAL GENERAL LIABILITY PREM SES Ea occu ence $� ,OUO�OOO
CLAIMS-MADE � OCCUR MEP EXP (Any ane person) $� 0�0�0
PERSONAL & ADV INJURY $'I �OOO�OOO
GENERAL AGGREGATE $ZaQOU�OOO
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - GOMP/OP AGG $Z�OOO�OOO
POLICY PR� LOC $
A AUTOM0614E 41AeILITY 6602432R749 6/18/2011 06/18/201 COMBINED SINGLE IIMIT $
(Ea accident) 1 0�� 0�0
ANY AU70 BODILY INJURY (Per person) $
ALL OWNED AIJTOS BODILY INJURY (Per accidan[) $
SCHE�ULED AUTOS PROPER7Y dAMAGE $
X MIREP AUTOS
(Per �ccident)
$
X NON-OWNED AUTOS . ..
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE H, $
EXCE38 LIAB CLAIMS-MADE AGGREGATE $
DE�UCTIBLE ` �� �m
REfENTION $
� WORKERSCOMPENSATION U67080Y545 9/01/2011 09/01/201 X WC57AiU- pTH-
AND EMPLOYER3' LIABILITY y� N
ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N�A E.L. EACH ACCI�ENT $� OO�OOO
OFFICER/MEMBER EXCLl1DED7
(Mandetory In NH) E.L. DISEASE - EA EMPLOYEE $� OO�OOO �
If yes, descri6e under
l]ESCRIPTION OF OPERAilONS below E.L. QISEASE - POLICY LIMIT $rJOO�OOO
C Professional bPR9697163 09/11/20/1 09/11/201 $1,000,000 per claim
Liabil�t $1,Q00,000 annl a r.
DESCRIpTION OF OPERATIONS / LOCATIONS / VEHICLES (AtWch ACORD 107, Addltlonal Remarka Schedule, If mare space Is raqulred)
Professianal Liability coverage is written on a claims-made and reported basis.
,��� ��,�,,��
City of Clearwater �E� � � �011
Attn: City Clerk ,�Js � ��.I� �+L���i��� ��,,i
PO Box 4748 {�� , . Cw„a,
Clearwater, FL 33758-4fi�8�����V`� `-`�"°�'`''�� ���
SHOULD ANY OF THE ABOVE DESCRIBED POLICI�S BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL B� bELIVERED IN
ACCORDANCE WI7H THE POLICY PROV151QN5.
AUTHOItIZED R�PRESENTATIVE
pL� � 0�...oL.� ,�.+�--�
C� 1988-2009 ACORD CORPQRATIdN. All rights reserv�d.
ACORD 25 (2DQ9I09) 1 of 1 The ACOFtD name and logo are registered marks of AC�RD
#S339767/M339760 MRL