CERTIFICATE OF LIABILITY INSURANCE (192)Client#: 2476 HARVJOL.3
ACORD� CERTIFICATE OF LIABILITY INSURANCE ��oizsizo��
7HI5 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPQN THE CERTIFICATE HOL.DER. TWIS
GERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR AL7ER THE COVERAGE AFFQRDED BY TFiE POLICIES
BELOW. THIS CER7IFICATE OF INSURANCE DOES NpT GONSTITUTE A CONTRACT BETWEEN THE ISSUING� INSURER(S), AUTHORIZED
12EPRESENTATIVE OR PROpUCER, AND TME CERTIFICATE IiOLDER.
IMPOIt7ANT: If the c�rtificate holder is an ADDITIONAL INSURED, the palicy�ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and condltlons of the policy, certain pollcles may require an endorsement. A stat�ment on this certi9icate does not confer rights to the
certificate holder in Ifeu of such endorsement(s).
PRODUCER � �
NAME:
ISU Suncoast Insurance Assoc PHONE g13 289-52U� aC No : 813 289-�1561
NC No Ext :
P.O. BOX ZZSBS E-MAIL
ADURESS:
Tampa, FL 33622-2668 �
CUSTOMER ID #:
813 289-5200
INSURER(S) AFFOROING COVERAGE NAIC #
iNSUReo ,NSURERa• Phoenix Insurance Company 25623
Harvard Jolly, Inc.
2714 Dr Martin Luther King Jr St N
St Petersburg, FL 33704
f'.AVFRAPFS CERTIFICATE NLIM6ER:
iNSUReR s: Commerce 8� Industry Ins Co
iNSUReR c� Travelers Casualty & Surety Ca
INSURER E :
REVISIQN NUMB�R:
19410
19038
THIS 15 TQ CERTIFY THAT THE POLICIES OF IN$UR,4NCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEp ABOVE FOR THE POLICY P�RIQb
INDICATEP. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CQNTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFpRDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE iERMS,
EXCLUSIQN$ AND CONDITIONS OF SUCH PDIICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Ns TYpE QF INSURANCE pL UBR pO�IGY NUMBER MMlDD eIYYYY pMMfDD/YYW LIMITS
A GENERAL LIABILITY 6801709P725 7 7/08/2011 11/0$/201 EACH OCCURRENCE $1 000 000
X COMMERCIAL GENERAL LIABILITY PREM SES Ea occu encs �� ,OOO,OOO
CLAIMS-MADE � OCCUR ME� EXP (Any one person) $� 0 000
PERSONAL & AdV INJURY $� ,DOOrOOO
GENERALAGGREGATE $�,OOQ�OOO
GEN'L AGGREGATE LIMIT APPLIES PER: PRO�UCTS - COMP/OP AGG $Z,OOO�OOO
PRO- -���� -� _. $
POLICY X LOC � �
AUTOMpBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea accident)
ANYAUTO ��� � � �O �
BODILY INJLIRY (Per person) $
ALL OWNE� AUT�S eOl]ILY INJURY (Per accident) $
SCHEpULED AUTOS -- . � � �v., ,.., r,. ;, PROPERTY DAMAGE $
,.,e. . u wewD��. �� (',�., ..W � ,..... ` d -..'�._ .� (Per eccident)
NIRED AUTOS , , ,�„I�� . .
NON-OWNED AUTOS I_-. ,_..�9`.�_3 G �:' =..; r �. !✓.,,1' � ...._... $ _._
$
g X UMBRELLALIAB X occuR EBU01/655747 11/OS/2Q11 11/08/201 EACH pCCURRENCE s4 000 000
_ EXCESS LIAe CLAIMS-MA�E AGGREGATE $� OOO OOO
�EDUCTIBLE � -`�
R T TION $
� WORKERSCOMPENSAT1pN UB5238Y879 1/07/2011 01/01/2q1 X WCSTATU- OTH-
ANU EMPLOYERS' LIAeILRY
ANY PROPRIETORlPARTNER/EXECUTIVEY❑ E.L. EACH ACCIDENT $� �OUO�OOO
OFFICERlMEMBER EXCLU�ED? N�A`
(Mandatory In NH) E.L. �ISEASE- EA EMPLOYEE $� �����Q��
If yes, describe under
DESCRIPTION OF OP RATIONS below E.L. pISEASE - POLICY LIMIT $�,OOO,OOO
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACOR� 101, Addltlonal Remarks Schadule, If mor4 apace Is requlred)
RE: Architect af Record Agreement RFQ 14-11 Professional Services. The City of Clearwater is listed as an
Additional Insured as respects the Commercial General Liability and Excess Liability policies where raquired
(See Attached Descripti�ns)
w������e.wrr ���� r��ra I�A�If�CI 1 A71AAI
City of Clearwater
Attn: City Clerk
Post OfFice �ox 47�18
Clearwater, FL 33758-4748
SHOULD ANY OF THE ABOVE D�SCRIBED POLICIES BE CANCELLED S�FORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCURDANCE WITH THE PQLICY PROVISIONS.
AUTHORIZED REpRESEN7A71VE
� � oc9.� -a� od�.-e� ,��
(�1988-2009 ACORD CORPORATION. All rights�reserved.
ACORD 25 (2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD
#5348185lM$48159 KEB
DES�CRIPTI�]NS`'(�!�n'��n.ued from Page 1) ;
by a written cantract prior to a loss per policy terms and conditions. Walver of Subrogatian in favor of
the C�ty df Clearwater applies ta the General Liebility, Workers' Compensation and Professional Liability
policPes. The City shall be notified at least thirty (30) days in advance of cancellation or non-renewal.
Professional Liability deductible is $150,000 each claim.
;�
AMS 25.3 (2009I09) 2 of 2
#5348185/M348159