CERTIFICATE OF LIABILITY INSURANCE (202)��!`« CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYI�
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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
Willis of Illinois, Inc.
233 S. Wacker Dr
Ste 2000
Chicago IL 60606
INSURED
H.W. Lochner, Inc.
20 N. Wacker Drive
Suite 1200
Chicago IL 60606
INSURER B :
INSURER D :
INSURER F :
��•��+�_� tLtKIltll:Alt NUMI3tK:4�EZ47'I68 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
IND►CATED. NOIIMTHSTANDING 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 ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE IN R POLICY NUMBER MM/DDlYYYY MM/DD/YYYY LIMITS
GENERAL LIABILITY RE��E� EACH OCCURRENCE $
DAMAGE TO RENTED
COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $
CLAIMS-MADE � OCCUR MED EXP (My one person) $
MAY2� 2012 PERSONAL & ADV INJURY $
GENERALAGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: �1�5 D PRODUCTS - COMP/OP AGG $
POLICY PR� LOC O��I��� �V S
AUTOMOBILE LIABILITY MBIN IN L LIMIT
Ea accident
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY Per accident $
AUTOS AUTOS � )
HIRED AUTOS NON-OWNED PROPERTY DAMAGE
AUTOS Per accident $
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ g
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS LIABILITY Y/ N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑ N� A E.L. EACH ACCIDENT $
(Mandatory in NH)
E.L. DISEASE - EA EMPLOYE $
� If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Professional Liability 4177432 /1/2012 /1/2013 $1,000,000 Per Claim
$1,000,000 Aggregate
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 701, Additional Remarks Schedule, if more space is required)
GERTIFICATE
City of Clearwater
Attention: City Clerk
P.O. Box 4748
Clearwater FL 33758-4748
ACORD 25 (2010/05)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
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