CERTIFICATE OF LIABILITY INSURANCE (204)Client#: 2749 PLISARC3
ACORD,� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY1n
— 5H 5/2012
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 certi�cate dces not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER NAME:
ISU Suncoast Insurance Assoc a�"N �: 813 289-5200 ac, No : 813 289-4561
P.O. Box 22668 _
ADDRESS:
Tampa, FL 33622-2668
CUSTOMER ID #:
813 289-5200
INSURED
Plisko Architecture, P.A., AIA
800 Drew St
Clearwater, FL 33755
INSURER(S) AFFORDING COVERAGE NAIC #
iNSUReRn: Phoenix Insurance Company 25623
iNSUReR e: Travelers Casualty 8 Surety Co 31194
iNSUReR c: XL Specialty Insurance Company 37585
INSURER D :
INSURER E :
INSURER F :
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 CONDI710N 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,
EXClUS10NS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE � R POLICY EFF POLICY EXP
TR N POLICY NUMBER MM/DD MM/DD LIMITS
A GENERAL LIABILITY 6602432R749 06/18/2012 06/18/201 EACH OCCURRENCE $� 000 ���
X COMMERCIAL GENERAI LIABILITY PREM SES EaEocc rtence $�,OOO,OOO
CLAIMS-MADE � OCCUR MED EXP (Any one person) $� �,00�
PERSONAL 8 ADV INJURY $� �OOO�OOO
GENERALAGGREGATE $Z�OOO�OOO
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $Z,OOO,OOO
POLICY PR� LOC $
A AUTOMOBILE LIABILITY 6602432R749 06/18/2012 06/18/201 COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $1 000 000
BODILY INJURY (Per person) $
ALL OWNED AUTOS BODILY INJURY (Per accident) $
SCHEDULED AUTOS
PROPERTY DAMAGE $
X HIREDAUTOS (Peraccident)
X NON-OWNED AUTOS $
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $
B WORKERSCOMPENSATION U67080Y545 9/01/2011 09/01/201 X WCSTATU- OTH-
AND EMPLOYERS' LIABILITY �
ANY PROPRIETOR/PARTNER/EXECUTIVEY� E.L. EACH ACCIDENT $� OO�OOO
OFFICER/MEMBER EXCLUDED? N�A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $� ��,�0�
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $rJOO�OOO
C Professional DPR9697163 09/11/2011 09/11/201 $1000, 0 r
Liabili $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 107, Additional Remarks Schedule, If more space is required)
Professional Liability coverage is written on a claims-made and reported basis.
MAY 16 2012
CERTIFICATE H�LDER CANCELLATI�N
City of Clearwater
Attn: City Clerk
PO Box 4748
Clearvvater, FL 33758-4748
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
0� "' ''� OC9.-aL.o ,�r�-----
01988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD
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