CERTIFICATE OF LIABILITY INSURANCE (205)Client#: 2962 SDIENVI3
AC814d,� CERTIFICQTE OF LIABILITY INSURANCE D5/21/2012 )
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 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
wc No eXc : cac, No : 813 289-4561
P.O. BOX ZZSGB -MAIL
ADDRESS:
Tampa, FL 33622-2668
CUSTOMER ID #:
813 289-SZOO INSURER(S) AFFORDING COVERAGE NAIC #
INSURED
S D I Environmental Services, Inc.
3816 W Linebaugh Avenue #200
Tampa, FL 33618
iNSUReRn: Endurance American Specialty In 41718
iNSUReR s: Travelers Indemnity Company 25658
�r,suReR c: Travelers Casualty 8� Surety Co 31194
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 D L POLICY EFF POLICY EXP LIMITS
T TYPE OF INSURANCE R POLICY NUMBER MM/DD MM/DD
A GENERAL LIABILITY ECC101013105 09/02/2011 09/02/201 EACH OCCURRENCE s1 000 000
DAMA E O RENTE
X COMMERCIAL GENERAL LIABILIN PREMISES Ea occurrence $rJO,OOO
CLAIMS-MADE a OCCUR MED EXP (My one person) $rJ,00�
X BI/PDDed:5,000 PERSONAL&ADVINJURY $�,OOO�OOO
GENERAL AGGREGATE $Z,OOO�OOO
GEN'L AGGREGATE LIM�T APPLIES PER: PRODUCTS - COMP/OP AGG $� �OOO�OOO
POLICY PR� LOC $
B AUTOMOBILE LIABILITY BA2562L144 07/29/2011 07/29/201 COMBINED SINGLE LIMIT
(Ea accident) $� ��� ���
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED AUTOS BODILY INJURY (Per accident) $
SCHEDULED AUTOS
PROPERTY DAMAGE $
X HIRED AUTOS (Per accident)
X NON-OWNED AUTOS
$
$
B �( UMBRELLA LIAB X OCCUR CUP6416Y164 06/30/2012 06/30/201 EACH OCCURRENCE $� �00,���
EXCESS LIAB CLAIMS-MADE AGGREGATE $� OOO OOO
DEDUCTIBLE $
X RETENTION � OOOO $
C WORKERSCOMPENSATION U67082Y944 09/01/2011 09/01/201 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 $� �OOO,OOO
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $� �OOO�OOO
A Professional ECC101013105 09/02/2011 09/02/201 $1,000,000 per claim
Liabilit $2,000,000 annl a r.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attaoh ACORD 701, Additional Remarks Schedule, if more space Is required)
Professional Liability coverage is written on a claims-made and reported basis.
REC.�I�/�D
CERTIFICATE
City of Clearwater MAY 2 2 2012
Attn: City Clerk ��F��� R�GDRD$ A�I�
PO Box 4748 ��� $�� D��
Clearwater, FL 33758
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
,Tj����1���! �
07988-2009 ACORD CORPOi2ATION. Ali rights reserved.
ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S385146/M385141 AGB