CERTIFICATE OF LIABILITY INSURANCE (190)Client#: 6108 GRIMCRA3
acoRO,� CERTIFICATE OF LIABILITY INSURANCE ��O��OIZO� iYY)
THIS CERtIFICATE IS ISSUED AS A MATfER OF INFQRMATIQN ONLY AND CONFERS NO RIGMTS UP�N THE CERTIFICATE HOLDER. TNIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER TNE COVERAGE AFFORD�D BY TNE� POLICIES
BELOW. 7HIS CERTIFICATE OF INSURANCE DQES NOT CONSTITUTE A CON7RACT BETWEEN TNE ISSUING INSURER(S), AUTHORIZED
REPFtESENTATIVE OR PRODUCER, ANb 7HE CERTIFICATE WOLDER.
IMPURTANT: If the oertificate holder is an ADDITIQNAL INSURED, the policy(i�s) must be endorsed. If SUBRUGATION IS WqIVED, subject to
the terms and conditions of the policy, certaln polici�s may require an endorsem�nt. A sWtement on thls certificat� do�s not confer rights to the
certlTicate holder in lieu of such endorsement(s).
PRODUCER NAME:
ISU 5uncoas# Insurance Assoc PNONE $13 289-5200 F� No : 813 289-4561
A/C No Ext :
P.O. Box 22668 -
ADDRE$S:
Tampa, �L 33622-2668
CU TOMER ID 71:
813 289-52QQ
INSURER(S) AFFORDING COVERAGE NAIC #
iNSU��o
Grimail Crawford, Inc.
4600 W. Cypress St., Suite 550
Tampa, FL 33607
�NSUeeR a� Phoenix Insurance Company 25623
�NSUReR e: Travelers Casualty and Surety C��� 19038
iNSURER c: Everest National Insurance Comp 10120
INSURER D :
INSUREFi E :
_
_.
_. ., .. .._ _, . _. . . _ ' INSURER F :
COV�RAGES GERTIFICAtE NUMBER: REVISIQN NUMBER:
THIS IS TO CERTIFY THAT 7HE POI.ICIES OF INSURANCE LISTED B�LOW HAVE BEEN ISSUED TO THE INSUFiED NAMEp ABOVE FOR THE PpLICY PERIOD
INDICATED. NOTWITHSTANDING ANY FiEQUIREMENT, TERM pR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WI7H RESPECT 70 WHICH THIS
CERTIFICATE MAY BE I55UEp OR MAY PERTAIN, THE INSURANC� AFFORI7ED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIQNS AND CONDITIONS OF SUCH PpLICIES. LIMITS SHOWN MAY HAV� BEEN REDUCED BY PAID CLAIMS.
IN POIICY EFF PpLICY EXP
� TYPE OF INSURANCE p POLICY NUMBER MM/DD/YYYY MM/DDIYYY LIMITS
A GENERAL LIABILITY 6805280�.540 10/14/2011 10/14/201 E4CH OCCURRENCE s2 000 000
X G4MMERCIAL GENERAL LIABILITY pFIEMISES Ea occu �nce S1 OOO OOO
CLAIMS-MAOE � OCCUR MED EXP (My one person) $1 �,��0
PERSONAL & A�V INJURY S2�OOO�OOO
GENERALAGGREGATE Sa�OOO�OOO
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUC7S - COMP/OP AGG $4�000�000
POLICY PRO- �� $ �yu�TT
A AUTOM081LE LIABILITY BA22QM6'.��s r' � �,� �j/2010 11/30/2011 COM8INED SINGLE LIMIT $
x (Ee eccident) 1 OQp QOQ
���:.:::_, _,..
X ANY AUTO `���� BO�ILY INJURY (Per person) $
ALL QWNED AU70S
OC 1 �� U�� BO�ILY INJURY (Per accidenq $
SCHE�ULEQ AUTOS PRpPERTY DAMAGE
X HIRED AL1Tp5 (Per accidenq $
X NON-OWNEP AU7pS $
�� �'`o��l�►A. ��t:.'�",�:� �a�d� .._�_.. .W_w.._..._.�
,� p . F, �r � s
lJMBRELLA LIAB pCCUR EACH OCCURRENCE $
EXCE55 LIAB CLAIMS-MA�E AGGREGATE $
DEDUCTIBLE - __._ -- — -- �.__. ,.. �.._ — _�-- - . _..�.._--_�.__ $ _.�. �
RETENTION � $
� WORKERS COMPENSATIpN UB6100Y759 5/22/2011 05/22/201 X WC STATU- OTH-
ANO EMPLOYERS' LIABILITY
ANY PROPRIETORlPARTNER/EXECUTIVEV❑ E_L. EACH ACCIDENT $�I ,OOO�OOO
QFFICEFYMEMBER EXCLU�ED? wA
(Mendatory In NH) E, L. bISEASE - EA EMPLOYEE $1 �OOD�OOO
It yes, descr�be under �� OOD DOO
DESCRIPTION OF OPERATIONS below E.L_ OISEASE - POLIGY LIMIT �1, ,
C Professional 79AEOOp413111 05/29/2011 05/29/2p1 $2,000,000 per claim
Liabili $2 000 000 annl a r.
PESCRIPTI4N OF OPERATIONS / LOCA710N8/ VEMIC4E5 (Attach ACORD 101, Addltlonel Remarks SchedulB, If more apece Is requlred)
Profes.sional Liability is written on a Claims Made and Reported Basls.
RE: City of Clearwater Engineering of Record
City of Clearwater
Englneering Dept. 5te. 200
Attn: Susan Chase
PO Box 4748
Clearwater, FL 33758-�4748
&MOULD ANY OF THE ABOVE DESCp18Ep POLICI�S B� CANCELLED BEFORE
7HE EXPIRATION �ATE THEREOF, NOTICE WILL BE DEI.IVERED IN
ACCORDANCE WITH iHE POLICY PRpVISIpNS.
AUTHORIZEP REPqESENTATIVE
pL� � Q�--N.+� ��--�
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ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are reglstered marks of ACQRD
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