CERTIFICATE OF LIABILITY INSURANCE (4)Client#: 2476 HARVJOL3
ACORDTM CERTIFICATE OF LIABILITY INSURANCE D12/23/2011rr)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE 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 BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
NAME:
ISU Suncoast Insurance Assoc PHONE g13 289-5200 F'°X
euc No e:t : ac, Na�: 813 289-4561
P.O. Box 22668 E-MAIL
ADDRESS:
Tampa, FL 33622-2668
CUSTOMER ID #:
813 289-5200
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED
Harvard Joliy, Inc.
2714 Dr Martin Luther King Jr St N
St Petersburg, FL 33704
iNSUReRa: Phoenix Insurance Company 25623
iNSUReR s: Commerce & Industry Ins Co 19410
iNSUReR c: Travelers Casualty 8 Surety Co 31194
INSURER E :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TypE OF INSURANCE DDL UBR POLICY EFF POLICY EXP LIMITS
LTR N D POLICY NUMBER MM/DD/YY MM/DD
A GENERALLIABILITY 6801709P725 11/08/2011 11/08/201 EACHOCCURRENCE $��0�0���0
DAMAGE TO RENTED
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $� �OOO,OOO
CLAIMS-MADE � OCCUR MED EXP (Any one person) $� 0�0��
PERSONAL&ADVINJURY $�,OOO,OOO
� �,�``�1 GENERAL AGGREGATE $Z�OOO,OOO
GEN'LAGGREGATELIMITAPPLIESPER: ����4�" t'-'''�'��' PRODUCTS-COMP/OPAGG $ZOOO�OOO
� ;�.,,'o�' �- r
POLICY X PR� LOC $
AUTOMOBILE LIABILITY p��p �"�' '��`,: COMBINED SINGLE LIMIT
p�`� ,; . Y��' ' (Ea accidenq $
ANY AUTO � BODILY INJURY (Per person) $
ALL OWNED AUTOS
,r•'gg fi;r� � ',� � ` BODILY INJURY (Per accident) $
SCHEDULED AUTOS y0i " ` .
��� PROPERTY DAMAGE
HIREDAUTOS j" ` (Peraccident) $
NON-OWNED AUTOS $
$
g X UMBRELLA LIAB X occuR EBU017655747 11/08/2011 11/08/201 EACH OCCURRENCE $4 000 000
EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000
DEDUCTIBLE $
RETENTION $
`+ WORKERSCOMPENSATION U65238Y879 01/07/2012 01/01/207 X WCSTATU- OTH-
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVEY � N E.L. EACH ACCIDENT $� ,OOO,OOO
OFFICER/MEMBER EXCLUDED? � N�A
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $�,�00,�00
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $� �OOO,OOO
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
RE: Architect of Record Agreement RFQ 14-71 Professional Services. The City of Clearwater is listed as an
Additional Insured as respects the Commercial General Liability and Excess Liability policies where required
(See Attached Descriptions)
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Attn: Cit Clerk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Y ACCORDANCE WITH THE POLICY PROVISIONS.
Post Office Box 4748
Clearwater, FL 33758-4748 AUTHORIZED REPRESENTATIVE
OL-�' '�"� 0�.-C1L., .�J.�---'--,..
O 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD
#S357294/M357268 KEB
AMS 25.3 (2009I09) 2 of 2
#S357294/M357268