CERTIFICATE OF LIABILITY INSURANCE (191)AC � � onreaMainoii�)
� CERTIFICATE OF LIABILITY INSURANCE
THIS CERTIFICATE IS ISSUED A5 A MATTER OF INFORMATION ONLY AND CONFERS Nb RIGHT$ UPON tHE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVEliAGE AFFpRDEU BY THE POLJCIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CpNSTITUTE A CONTRAC7 BETWEEN THE ISSUING IN&URER(5), AUTHORIZED
REPRESENTATIVE QR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certlfleate holder is an ADDITIONAL INSURED, tha pollcy(lesj must be andorsed. If Sl1BROGATION IS WAIVED, sub)ect to
the terms and cbndltlons of the pollcy, certain policies may require an endorsement. A stat�mer�t on this certiflcate dces not confar rights to the
cert�cate holder In Ifeu of such endorsement(sJ.
PROOUCER ���
NA�E:
AOf1 RlSk II15U�8nCe S2f VlCES W25t, Ifl[. A E
LOS Arlg el es CA Of'fl C2 py�j p, Ex� ;(866) 263-7122 aC No _ C847) 953-5390
707 wilshire eoulevard E��
Suite 2600 nookESS:
LOS angel es CA 90017-�460 USA INSURER�S) AFFORDING COVERAGE NAIC #
retra rech, znc.
5601 Mariner Street, suite 490
rampa FL 33609 USn
NsurrER a National union Fire Ins co of Pittsburgh 19445
NsuReRS: snsurance Company of the State of Pa 19429
�sue�ec: Chartis specialty Insurance company 2G883
wsu�eo: �exington rnsurance Company 19437
MSURER E:
INSURER F:
COVE ES CERTIFICATE Nl1MBER: 570043996468 REVISIOPI NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSl1RANCE LISTEP BELOW FiAVE BEEN ISSUE� TO TNE INSUREP NAMED ABOVE FOR THE PQLICY PERIOD
INDICATED. NQTWITHSTANDING ANY REqUIREMENT, TERM OR CONDITION OF ANY CON7RACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFIGATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORpED BY TWE POLICIES DESGRIBED WEREIN IS SUBJEGT 70 ALL THE TERMS,
EXCLUSIONS AND GONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY MAVE BEEN REDUCED BY PAID CLAIMS. LimNs shown are as request�
LTIY
'IYPE OF INSURANCE INeR WVD p���CY NUMBER MMID� M P LIMIT5
A GENERAL LIABILITY GL EACH OCCURRENCE $1, OQO, OC
X COMMERCIALGENERALLIABILRV j.'-G�����1 ��'�•• t� S1,OOO�OC
!.', �..,�` ..`n. , p,.. W� MISES Ea occurrenca
� MED EXP (MY one person) �1� � ��
CLAIMS-MA�E X❑ OCCUR •• �.- ... �... .. -. . .. . -..
PER90NAL d ADV INJl1RY $1, OOO , O�
X X,C,LI Goverege �,� ��� �,
GEN'L AGGREGA7E LIMIT APPLIES PER:
POLICY X PR� X LOC
� AU70MOBILE LIABILITV
J( ANY AUTO
ALLOWNEO SCHEdULED
A11T05 AUTOS
X HIREDAUTOS X NON-OWNED
Al1T0S
p X UMBRELLA LIAB X OCCUR
EXCE58 LIA9 CLAIM5-MAOE
DED REfEN710N
9 WORKERS COMPENSA710N AND
� EMPLOYERS' LIABILITY Y I N
ANV PROPRIETOR / PARTNER / E}�CLfTIVE ❑
B OFFICER/MEMBER EXCLl1OED7 N N I A
(Mandatory in NH)
1} as, descrl6e under
n�ACRIPTION OF OPERATIONS bBloW
����1 � �„�� GENERALAGGREGATE
� ��
PRODUCTS - COMPIOP AGG
E.��"'s��Y,.�Tm��: �,�V�i:;:
�,
wC20635698
wC20635699
Prof/POII �iab
YO/Ol/2012 COMBINED SINGLE LIMIT
� 80dILY INJURV ( Per peraon)
BODILV INJURY (Per axident)
PROPERT'I�AMAGE
Peracddent
10/O1 2012 Ep,CH OCCURRENCE
AGGREGA7E
10 1 2 1 X WC 3TA7U- OTH
10/Ol/201Z 7ORY LIMITS
10/Ol/201Z E.L. EACH ACCIDENT
E.L. DISEASE-EA EMPLOYEE
E.L, 41$EASE-POLICY LIMIT
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Agggregate -
az,000,000
sz,000,000
55,000,000
$5,000,000
E1,OOO,00a
$i,000,00a
$1,OOO,DOC
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DESCRIPTIDN OF OPERATION81 LOCATION3l VENICLES (AttaCh ACORD 107, Addlden0l ROmarka Schedulo, N mOre 6peCB IS reqUlrod) �
Referen[e: city of Clearwater - 2009 engineer af Record - Start oate: 8/10/2009 - End �ate: 8/10/2012 rhe City of clearwater is �
included as additional insured under the Commercial General Liability and Auto policies where required by written .-��'
contract and such insurance is primary and non-contributory where required 6y written contraCt.
�
CERTIFICATE HOLDER GANCELI.ATION �=
SHplll➢ ANY OF TME ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL 8E DELNERED IN ACCOROANCE WITH THE -
POLICY PROVISIONB.
City of Clearwater AU7HORIZEbREPRESENTATNE _
Attn: City clerk
PO 60x 4748 �� /'7� „��� �`�� pj//' ��
Clearwater F� 33758-4748 USn tt�. `" ��
�7988-2070 ACORD CQRPQRATION. All rights reserved.
ACORD 25 (2010I05) The ACaRD name and logo are registered marks of ACORD