CERTIFICATE OF LIABILITY INSURANCE (193)-�
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Client#: 584486 LEGGEBRA
ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE�MM/DD/VWI�
1 p/25/2011
THIS C�R7IFICATE 15 ISSUED AS A MA7TER OF INFORMATION ONLY AND CONFERS NO RIGMTS UPON THE CERTIFICA7E HOLDER. THIS
CEHTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT 8E'IWEEN THE ISSUING INSURER(5), AUTHORIZED
HEPRESENTATIVE OR PROpUCER, AND THE CERTIFICAtE HOLDER.
IMPORTANT: If the certlticate holder is an ADDITIQNAL INSURED, the policy(ies) must be endorsed. If SUBROGAiI�N 15 WAIVED, suhJect to
the terms and conditlons af the policy, certein policles may require an endorsement A statement on thls certificate does not confer rights to the
certificate holder in lieu ot such endorsement(s).
PRODUCER CONTACT
NAAAE:
USI Ins. Services of CT, Inc. P�N �, 203 634-5700 N, ; 203 634-5701
530 Preston Avenue eaua�.
ADDRES5:
Meriden, CT 06450 INSUFIEFI AFFORDING COVERAGE NAIC i
203 634-5700
INSURED
Leggette Brashears & Graham, Inc.
4 R�search Drlve
Suite 301
Shelton, CT qfi484
iNSUwwa: Hartfard Fire Insurance Co
iNSUROr e: We�ard Casualty Insurance Gom
iNSUaea c; HartFord Accldent & Indemnity C
�usuaFa n• Chartis Specialtv Insurance Com
19682
29424
22357 `�
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THI�` IS TO C�RTfFY"THP,T THE POLICIE5 OF INSURANCE LIS'fE6BELOW HAVE-BEEN ISSUED 707HE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATEO. NOTWI7NSTAN�ING ANY REQUIREMENT, T�RM OR CONDITION OF ANY CONTFiACT OR OTHER DOCl1MENT WITH FIESPECT TO WHICH TNIS
CERTIFICAT� MAY BE ISSUE� OR MAY PERTAIN, THE INSURANCE AFFOR�ED BY THE POLICIES DESCRIBED HEREIN IS 5Ue.lECT TO ALL THE TERMS,
E7CCLUSIDNS AND CON�I110NS OF SUCH PDLICIES. LIMITS SHQWN MAY HAVE BEEN REDUCED BY PAID CWMS.
INSR ADD $U8R POLJCY pOLJCY EXP
LTR TYPE OF INSURANGE pOLJCY NUMBER M � M D LIMITS
A GENERALLIABILITY 31 UUNZK6256 11/01/2011 11/Ui/201 EACH OCCURRENCE s1 000 000
X COMMERCIAL GENERAL LIABILITY ������ � oNTED $�OO OOO
CLAIMS-MADE � OCCUR MED EXP An one rson S 1 O OOO
X contl'aCtu11 PERSONAL & ADV INJURY s 1 000 000
X X C U included GENERALAGGREGATE S.3 �� �OQ
GEN'LAGGqEGATELIMITAPPLIESPER: PROpUCTS-COMP/OPAGG $$OOOOOO
POLICY jRa LOC $
B AUTOMOBILELJABILITY 31UENZK6066 11/01/2011 11/01/201 �afl�IdBDSINGLELIMIT $1000000
X ANY AUTO BOpILY INJURY (Per person) $
ALLOVJNEp SCHEDULED BO�ILYINJURY Peraccident $
AUTOS AlIT05 ( )
X HIRED AUTOS x NON-OWNED PROPERTY DAMAGE $
AU70S per acdd
X rive Oth Car g
g X UMBRELLALIAB X occua 31XWUFC0726 11/01/2011 11/01/201 EACH OCCURRENCE s10 000 0�0
EXCE55 LIAB CLAIMS-MADE AGGREGATE �1 O OOO OOO
DED X RETENTION 1 D000 g
WOpKERS COMPENSATON WC STATU- OTH-
G 31WENJ0522 11/01/2011 11/�1/201 X
AN� EMPLOYER5' LIABILfTY
ANY PROPRIETORIPARTNEq�EXECUTIVE v N E.L. EACH ACCIDENT $1 OOO OOO
OFFICER/MEMeER EXCLUDED7 � N / A
(Mandatory in NH) E.L. DISEASE - EA EMPLOVEE S1 OOO QOO
Ifyes, desai6e under
OESCFtIPTION OF OPERATIONS below E.L. DISEASE - POLICV LIMIT $1 OOO OOO
D Ppllution/Profess CQPS3778313 06/17/2011 06/17/201 $5,000,000/$5,000,000
Liab claims made DED $50,000
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_ . .- -- -- - ----- - - - --.Y�.: �.�,- — — ,—� ..
DESCRIPiION OF OP�qATIONS / LOCATIONS � V�HICLES (Atlach ACORD 1D1, Addklonel Remarka Sehrdule, I{ more spece le requlred) �° ��-�� �� �.�-ry �.r ,� ..._. __
Ciry of Clearwater is named as Addltlonal Insured with respects to the above General Liablliry and ��� ����1�
Autamobile policies when required by written cantract in accordance in policy terms, conditions and
excluslon. __ ,
�A� . �:M,f +'' �'�,r . ,.� •
.�.�, ���:�..� �::v . . ..
�'��`C"���.�.TI'�i: W;��`�:;�. i��;.:, .
CERTIFICATE HOLD�R CANCELLA710N
City of Clearwatar 5NOULD ANY pF THE ABOVE DESCRIBED POLJCIES BE CANCELLEb BEFORE
THE IXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Attn: City Clerk ACCORDANCE WITH THE POLICY PROVISIONS.
100 S. Myrtle Ave.
CLEARWA7ER, FL 33758-4748 AU7HOR�D REPRESFNTA7IVE
� 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (201p/05) 1 of 1 The ACORD name and logo are registered marks of ACQRD
#S6569475/M6556204 DNSZP
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U51 Ins. Services of CT, Inc.
530 Preston Avenue
Meriden, CT 06450
203 634-5700
City of Clearwater
Attn: City Clerk
100 S. Myrtle Ave.
CLEARWATER, FL 33758-4748
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