CERTIFICATE OF LIABILITY INSURANCE (206) Clientt#.5243 ADVAEN 3
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ACOR& CERTIFICATE OF LIABILITY INSURANCE
I �,crYYYYI
SE 512312012
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 ICES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATWE OR PRODUCER,AND THE CERTIFICATE HOLDER,
IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)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 We certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CON
NAME:
ISIS Suncoast insurance Assoc PHONE ...m FAIX
A C Ha E -61 209-5200 (Afc,No: 613 289 4 861
P.O.Box 22666 L
ADDRESS:Tampa,FL 33622-266I8 ..
613209-a 00 CUSTOMER H)C
INSURERISI AFFORDING COVERAGE NAEC
INSURED Advanced Engineering&Design, Inc. INSURERA:Old Dominion Insurance Company 40231
� _ ,_ .—
INSURERB:Travelers Casualty&.Surety Cc ..31194
3931 68th Avenue North INSURER C: L Specialty Insurance Company 37885
Pinellas Park,FL 33781
INSURER D:
INSURER E
IN ORER F,
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER,
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTER BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATEI NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR DITHER 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.
INSrR PE®r INSURANCE OL POLICY EFF POLICY R IEY'XYP 1"
Y LIMITS
POLICY NUMBER AM O YYY t9
• GENERAL IJASILrrY BPG2647A 0211612012 02116/2013 EACH OCCURRENCE $1,000,000
�......
COMMERCIAL GENERAL LIABILITY DAMAGE S�a aas�n€a�i 50�I,000
I CLAIMS-MADE L l OCCUR MEO EXP(Any one person) $5,000
_ _ PERSi]NAL S ACIV INJIARY $1,000,000
,x,...,.. 4 GENERAL AGGREGATE. $2,000,000' _
GEN"L AGGREGATE UMIT APPLIES PER'
DUCTS-COMP)OP AGf+ s2,000,00
POLICY- _ l LOC
• AUTOMOBILE LIABILITY BP 2647A. fl2116120112 021161201 COMBINED SINGLE LIMIT $1'.�OQ0,e 000,_--
ANY AUTO} w .�.; _.
(Ea acadantl
BODILY INJURY(Per person) $
_
ALL OWNED AUTOS. �.."'f�11,( ��"1 BODILY INJURY(Per aodder11' $
SCHEDULED AUTOS -
(€ PROPERTY DAMAGE
HIRED AUTOS , (Per ecradent)
Vii. NOWOWNED AUTOS $ _....
UMBRELLA LIAR OCCUR ( �EACH OCCURRENCE'. $_
F_XrE t:tA6 ,gym T MA'Z MA0 I AGGREGATE $
H
DEDRJf;'TIHLE ._._._ u.. ——
RETENTf{F4J a ..._ $
AND WORKERS COM S"LIAETIMON A UB70 OY 90 910112011 091011201 wC sTATL- I�TH
YYeIRI�ERS cotrPENSATLON �
ANY PROPRIE"TORIPARTNER cECUTIVE YIN E.L,EACI-€ACCEDE $100 000
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH) EL.DISEASE-EA EMPLOYEE $100,000
If yes,describe un4ev ......_,_ u�-_-
LIES'CRIPTIONOFORERATICINSbeIGw E.L.DISEASE-POLfCYLEMfT $500,000
C Professional DPS9698779 211512012,021151201 2,000,000 perclairn
Llahlli 1 1 2,000,000 anal aggr,
DESCRIPTION Of OPERATIONS i LOCATIONS I VEHICLES(A4tacr ACORD fe'I,Additlenal Remarks Schedure;,if more apace Is required)
The City of Clearwater is listed as an Additional Insured as respects the Commercial General Liability
policy where required by a written contract prior to a lass per policy terms and conditions,Professional
Liability coverage is written on a claims-made and reported basis.
CERTIFICATE HOLDER CANCELLATION
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Atari,Kathy f3edini
THE EXPIRATION DATE.THEREOF',NOTICE WILL BE DELIVERED IN
y ACCORDANCE WITH THE POLICY PROVISIONS.
P.C.Box 4746
Clearwater,FL 33756.4746 AUTFiORQED REPRESENTATIVE
i
01958-2009 ACORD CORPORATION.All rights reserved.
ACORD 25(2009109) 1 of 1 'The ACORD name and logo are registered marks of ACORD
E365555IM368709 JIIIII3