CERTIFICATE OF LIABILITY INSURANCE (188)Client#: 5955 ADVASYS3
ACORD,� CERTIFICATE OF LIABILITY INSURANCE °og�2siZO1�""'
T'HIS CERTIFICATE IS ISSUED AS A MA7TER OF INFORMATIQN ONLY AND CONFERS NQ RIGWTS UPON THE C�RTIFICATE HOLDER. THIS
CERTIFICAiE D0�5 NOT AFFIRMATIVELY OR NEGA7IVELY AMEND, EXTEND OR ALTER THE COVEFtAGE AFFQRDEp BY TH� POLICIES
BELOW. 7HI5 CERTIFICATE QF INSURANCE DOES NOT CQNSTITUTE A CONTIiACT BETWEEN THE ISSUING INSURER(3), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CER7IFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIQN IS WAIVED, subJect to
the terms and condltions of the pollcy, certain poNcies may require an endarsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such �ndorsement(s).
PROOUCeR
NAME:
ISII Suncoast Insurance Assoc ac No �t : 893 2gg.5�00
ac No:8132894561
P.O. Box 22668
Tampa, FL 33622-2868 ADDRESS:
CUSTOMER ID #:
813 289-5200
INSURED
Advanced Systems Engineering, Inc.
PO Hox 1915
Oldsmar, FL 34677
INSURER(S) AFFORDING COVERAGE NAIC #
�NSUReaa: phoenlx Insurance Company 25623
�NSUReR e: Travelers Indemnity Company 25658
iNSURER c: Travelers Casualty and Surety C 19038
iNSURER � :
INSURER E :
IN8URER F :
COV�RAGES G�RTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT 7H� POLICIES OF IN$URANCE LISTED BELOW HAVE BEEN ISSUED Tp THE INSURED NAMED ABqVE FOR THE POLICY PERIpD
INDICATED. NOTWI7HSTANDING ANY REQUIREMENT, TERM OR CONDITIQN OF ANY C�NTFiACT OR OTHER DOGUMENT WITH RESPECT TO WNICH THIS
CERTIFICATE MAY BE ISSUEb OR MAY PERTAIN, THE INSURANGE AFFORDED 8Y THE POLICIES DESCRIBED HEREIN IS SUBJEG7 Tp ALL THE TERMS,
EXCLUSIONS AND CONDITIQNS OF SUCH POLICIES. LIMITS SHaWN MAY HAVE BEEN REDUCED BY PAIQ CLAIMS.
NSR TYPE OF IN3URANCE � POIICY EFF POLICY EXP
LT PpLICY NUMBER MMIDD MMlDD/YYYY LIMITS
A GENERAL LIABILITY 6Gp6851 L26A 10/02/2p11 10/02/207 FACH OCCURRENCE $'� ��� dd0
N ED dOO,OOO
X COMMERCIAL GENERAL LIAeILITY PREMISES Ea occurrence S� �
CLAIMS-MADE �X OCCUR MED EXP (My vne person) $� O�OOO
PERSONAL 8 ADV INJURY $�,OOO�OOO
GENERALAGGREGA7E $��OOO,OOO
GEN'L AGGREGATE I.IMIT APPLIES PER: PROOUCTS - COMPlOP AGG $Z�OQO,O�O
pOLICY PR� LOC $ �
p auroMOei�e �aBi�.irr 6606851 L26A 011 10/02/207 COMBINEO SINGLE LIMIT
���� (Ea aceiden[) $� o00 000
ANY AIJTO '"� BODILY INJURY (Per person) $
ALL OWNED AUTOS BO�ILY INJURY (Per accident) $
3CHEOULEDAUTOS SEP �.7 2�11 PROPERTVnAMAGE
X HIREDAUTOS (Psraccident) $
X NON-aWNEO AUTOS '��.5 A� 4f� ���� `�i $
1�. . i4 /`� R Q'6 hU�! •
$
B �( UMBRELLA LIAB OCCUR CUP6$49Y "' 08/17/201 EACH OCCl1RRENCE $�JL000 Q�0
SS L�A6 _ . �,^ .. -,_ AGGREGATE $J OOO OOO
DEDL1C71BLE �� T $ � '�'
X RE7ENTION � OOOO $
`+ WORKERS COMPENSATION UB68a8Y201 8/17/2011 08117/201 X WC 57ATU- OTH-
AND EMPLOYERS' LIABILITY Y/ N
ANY PRdPRIETORlPARTNER/EXECUTIVE E.L. EACH ACCI�ENT a500�O00
OFFICERIMEMBER EXCLUOE�� ❑ N/A
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $�JOO,OOO
If yes, descrlbe undar "�
DESCRIPTION OF OPERATIpNS balow E.L. DI5EASE - POLICY LIMIT $�SOO,OOO
UE8CRIPTION OF OPERATIONS I LOCATION8/ VEHICLES (Attach ACORD 101, Addltlonel Ramarks Schadule, If more space la raqulrad)
(See Attached Descriptions)
City of Clearwater SHOULD ANY pF THE ABOVE DESCRIBED POLICIES BE CANCELLEp BEFORE
Art17: Gity Clerk THE EXPIRATION DATE THEREQF, N0710E WILL BE DELIV�REp IN
ACCORDANCE WITH TW� POLICY PROVISIONS.
PO Box 4748
Clearwater, FL 33758-4748 AUTNbRIZED REPREBENTA7IVE
Or—� � QC�--L1L� �rr^��
�7988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) q pf Z The ACORD name and logo are registered marks of ACQRD
#S342285/M342281 BPK