FLORIDA GAS AND ELECTRIC CORPORATION - BID 04-08 - CERTIFICATE OF LIABILITY INSURANCE (4)�`` °RO� CERTIFICATE OF LIABILITY INSURANCE 1�Z�ZOj2YYY)
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 � � � � CONTACT Sandra Burdick �
NAME:
Northeast Underwriters Inc. ai� No Ext: �727� 521-4Z53 AIC No: �72��527-9455
4790 lst Street North A��R�ESS:sburdick@neu-ins.com
� �.� � � „ � . . � � _ _ � . . PRODUCER �y00003706 � �
St. Pe
INSURED
FL 33703
Florida Gas and Electric Corp
PO Box 280
Dade City FL 33526-0280
INSURERA:A�L1L'31 Insurance Company
iNSUReRe:General Ins Co of America
iNSUReRC:Travelers Excess&Surplus Lines
iNSUReRO:Bridaefield Casualtv Ins Co
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9696
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COVERAGES CERTIFICATE NUMBER:12-13 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 7ypE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP
LTR IN R WV POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ S� OOO � OOO
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISES Eaoccurrence $ 100,���
A CLAIMS-MADE � OCCUR X X 00001542002 1/1/2012 1/1/2013 MED EXP (Any one person) $ 5, D00
� � PERSONAL & ADV INJURY $ 1, OOO � OOO .
� - � � � GENERAL AGGREGATE $ 2 � OOO � OOO
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2� OOO , OOO
X POLICY PR� LOC $
AU70MOBILE LIABILITY COMBINED SINGLE LIMIT
(Ea accident) $ 1 � 000 � 000
X ANY AUTO
BODILY INJURY (Per person) $
B ALLOWNEDAUTOS 4CC29892410 1/1/2012 1/1/2013
BODILY INJURY (Per accident) $
SCHEDULED AUTOS
�� �' PROPERTY DAMAGE
j �'� �'�� `� Per accident $
X HIRED AUTOS r_ �; �p� �' g� �� ( )
X NON-OWNED AUTOS Uninsured motorist combined $ 1� 0�� , 0�0
a-° ��, ,.. $
X UMBRELLA LIAB OCCUR . � ��° -� �° EACH OCCURRENCE $ 4� OOO � OOO
EXCESS LIAB CLAIMS-MADE � • AGGREGATE $ 4� OOO � OOO
�� � �-F�5'�' , - - .
DEDUCTIBLE � �3i� ` ' "� � ' `
9E�•^ $
C X RETENTION $ � ZO OOO �'�e����� � '�-- - _� :to 1/1/2012 1/1/2013 $
D WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY �, � N � T R IM T R
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1 OOO OOO
OFFICER/MEMBER EXCLUDED? � N � A
(MandatoryinNH) 83033253 1/1/2012 1/1/2013 E.L.�DISEASE-EAEMPLOYE $ 1 ��� D0�
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ S OOO OOO
In13nd Marine M1154269302 08/31/201108/31/2012 glanketCoverage $t000Ded
Rented/Leased Equip
DESCRIPTION OF OPERA710NS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) �
It is agreed the Certi£icate Holder is named as Additional Insured's with respect to General Liability and Commercial
Auto Coverage.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN
City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: City Clerk
PO BOX 4748 AUTHORIZED REPRESENTATIVE
Clearwater, FL 34618-4748
Ken Kijowski/SMB --,�:.�"-�-� � r _���.-.-�--^m-.�-"`��-"-�--."-
ACORD 25 (2009/09) O 1988-2009 ACORD CORPORATION. All rights reserved.
INS025 �zoosos� The ACORD name and logo are registered marks of ACORD