CERTIFICATE OF LIABILITY INSURANCE (196)Client#: 6108 GRIMCRA3
ACORD,� CERTIFICATE OF LIABILITY INSURANCE D�1/142011Yy)
TMIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANp CONFERS NO RIGWTS UPON TH� CERTIFICATE WOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE CaVERAGE AFFORDED BY TME POLICIES
BELOW. THIS CER7IFICATE OF INSURANCE DOE$ NpT G�NSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFIGATE H04DE�R.
IMPOR7ANT: If the certificat� hold�r is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBRQGATION IS WAIVED, subject to
the terms and conditions of th� pollcy, certaln pollcies may require an endorsement. A statement on this certificate does not confer rlghts to the
certificate hold�r in lieu of such endorsement(s).
PROOUCe�
��:
ISU Suncoast Insurance Assoc P"o"E g13 289-5200 � N, ; 813 289-4587
A!C No Ext :
P.O. Box 22688 E-�a�
n�oRESS:
Tampa, FL 33622-2668 CUSTOMER ID N:
813 299-5200
INSURED
Grimail Crawfard, Inc.
46qD W. Cypress St., Suite 550
Tampa, FL 33607
-COVERAGES
CERTIFICA7E NUMBER:
INSURER(S) AFFOR�ING COVERAGE NAIC #
ir,suAen n: Phoenix Insurance Company 25623
iNSUReR B: Travelers Casualty & Surety Co 31194
�NSUReR c: Everest National Insurance Comp 10720
INSURER P :
REVISION NUMBER:
THIS IS Tp CERTIFY THAT TME f'O�ICIES OF INSURANCE LIS7ED BELDW HAVE BEEN ISSUEp TO THE INSUREO NAMEp ABOV� FOR THE POLICY PERIOD
INDICAT�D. NOTWITHSTANDING ANY REQUIREMENT, TERM pR CONDITION OF ANY CONTRACT pR OTHER DQCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSUfiANC� AFFORDED BY'fHE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS,
EXCWSIONS AND CONDITIONS OF 5UCH POLICIES. LIMIT$ SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IN5R TYPE OF INSURANCE �OL UBR pOLICY NUMBEp PRA�MNU/YYY INMNYWIE(YYY LIMITS
A GENERAL LIABILITY 6$0528QLS40 10/14/2011 10/14/201 EACH OCCURRENCE s2 000 000
X COMMERCIAL GENERAL LIABILITY pREM SES Ee oc urrence $1 OOO OOO
CLAIMS-MADE � OCCl1R MED EXP (Any one person) $� ��0��
PERSdNAL & ApV INJURY $Z OOO�QOO
GENERALAGGREGATE $4�QOO�OQO
GEN'L AGGREGATE LIMIT APP�IES PER: PROOUCTS - COMP/OP AGG $4�000�000
POLICY PR� LOC $
A AUTOMOBILE LIABILITY Bp220M6366 11/30/���,� 11/30/201 Ee ��Dt' INGLE LIMIT �
- ��`''y�n ,� � � i oao 000
X ANY AL1T0 l�� �e"�� 1 1''p, t��_;... BODILY INJURY (Per person) $
ALL OWNED AUTpS BODILY INJURY (Per aCCident) $
SCHEpULED AUTOS � �� ���� pFtQpEFi7Y DAMAGE �
X NIRED AU70S ��� (Per accidenq
X NON-OWNEb AUTOS $
� r'
f" ����ir.'�.� �.e`+I,.% $
UMBRELLA LIAB OCCUR � F�����,, '��: �� �� +�'� �ACH OCCURRENCE $
EXCESS LIAB GLAIMS-MADE AQOREGATE $
DEDUCTIBLE $
RE7ENTI N � �~ � ��
B WORKERS COMPEN5A170N U66100Y759 5/22/2011 05/22/201 )( WC STATU- OTH-
AND �MPI.OYERS' UABILITY
ANV PROPRIETOR/PARTNER/EXECUTIVEV�N E.L. EAGH ACCIDENT $1 OOO OOO
pFFIGER/MEM6ER EXCLUDED? � wA
(Mandatory In NH) E.l. pISEASE - EA EMPLOYEE $1 aOOO,���
It yes, descdbe under "� ' —'
DESCRIP710N OF OPERATIONS below E.L. �ISEASE - POLICY LIMIT $1 OOO OOO
C ProTessional 79AE000413111 5/29/2011 05/29/201 $2,000,000 per clalm
Liabilit $2 000 000 annl a r.
DESCRIPTION OF OPERA710N5 / I.00ATIONS ! VENICLES (Attaeh ACORD 101, Addltbnal Rem� Sehedule, H more space Is requlred)
Prafessional Liablllty Is wrltten on a Claims Made and Reported Basis.
RE: City df Clearwater �ngineering of Record
City of Clearwater
Engineering Dept. Ste. 200
Attn: Susan Chase
PO Box 4748
Clearwater, FL 33'i5$-4748
SHOULD ANY OF THE ABOVE DESCRIBED PdLICIES Bfl CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORpANCE WITW 7HE POLICY PROVI510NS.
AUTMORIZED REPRESENTATIVE
vL9�.� �,. 0�9--et�, ,�..�--�
� 1988-20�9 ACORD CaRPORATION. All rlghts reserved.
ACORD 25 (2q09/09) 1 of 1 The ACORD name and logo are registerad marks of ACORD
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