CERTIFICATE OF LIABILITY INSURANCE (207) I S DATT(MMiDWYYYY)
• 05.2212012
CERTIFCATE OF LIABILITY INM4NCE I
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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
na
the terms and conditions of the policy,certain policies may require an endorsement,A statement on this certificate does riot confer rights to the
certificate holder In lieu of such endorsernent(s).
PRODUCER NAME:
Aon Risk services South, Inc,
Franklin TN Office 2
501 Corporate Centre Drive E-9 IL 0
......
suite 3100 DRESSr
Franklin TN 37067 USA INSURER(S)AFrORDING COVERAGE NAIL III
-------------
INSURED INSURER A: XL specialty insurance Co 37885
malcolm Pirnie, Inc.. INSURER B: Greenwich insurance Company 22322
44 s. sroadwa
15,h & 16th F11.01's TNS"JR:Eli C'
white plains NY 10602 USA INSURER D:
INSURER E,
INSURER F:
COVERAGES CERTIFICATE NUMBER:570046331096 REVISION NUMBER: E-- Pf,:RlclD
THIS IS-F0—Cr
RTLFy THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTH POLICY
INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR 01-HER 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, Limits shown are as requested
LIMITS
TYPE OF INSURANCE ADDI SUB POLICY NUMBER DOWYYY
LTR tNSR-2�vo IMM;Upffyyy
q 1 $1'000,000
Q04rRALLIA51LITY -Is 7=1 110 01/0y/ zlm� EACH OCCURRENCE
General Liability WMA, ' ED $1,000,000'
COMNIF RC 141 GENERAL LIABILITY I-I TY ENISES Ea Cm"er'Ou,
,,A,M,-,,A.ADE rA'iOCCUR MED EXP IAny x-,nc�rsoR� 510,i1t1cJ
PERSONAL 6 ADV dKJUR Y S1,000,000
-EENLRZL7,6CREoA1L S2,000,000
GENI AGGREGATE LI IT APPLIES PcR: PRO WCTS COMP;C P AGG S2,000,0TO 2
M
POLICY 'X x I nrl
A AEC00107581U-7U1'/61/2012 0175172613 770 78 1 N T
AUTOMOBILE LIA811-ITY Auto (.AGSM 21 F d
9=LY INJURY{Fle,persona 0
X ANY AUTO z
— ALL OWNED -'.EDUI'ED BODILY INJURY(Pe,acvd-k) iU
— AUTOS `AUTOS PRO PERTY DAMAGE
NON•OWNE
X HIREO AUTOS X D AUTO'S
001075910 01/01/21T12 7�1/01/2013 EACH OCCURRENCE
X X UMBRELLA LIAS x OCCUR
'L Line el I a A.GREGAIE 11,000,000
UMBRELLA
EXCESS LIA
E X
EXCESS LJAB CL,6,IvS4,IAUE SIR applies per policy terns & conditions
RED} X RIiTLNTIQN110,000
'Sc..' RWD943516306 T1
;AIWORKERS COMPENSATION AND �TWRYCII''I:;: 71EOR"I
'Hip
EMPLO,YERS'LIABILTY Y;N E,L�EACH ACCIDENT S1,000,000
ANY FIRG PJE�-T OR�PARTNeR,EXECUI RVF
0
US
-E
OFFICE S,
(Ma�'d R4,1rmK-R EXCLUIA:0* N;A �EI DISCAS&EAE110PLOYEE I I�000,000;
atory in Nfl)
"T
11 r,�,aesenbe undvi El DISEASE-POLICYLIMO' S 1,Goo,(0)0 0
DESCRIPTION SCRIPTION OF OPERATIONS bNow
DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES(AAlach ACORD 101,AcIditlanol Remalks Schedule,if more space m reqd1mvi
Re: All Operations of the Named insured. city of Clearwater is included as Additional insured asbrequired by written contract,
but limited to the operations of the insured under said Contract, with respect to the General Liability, Auto Liability and
Umbrella Liability policies. General Liability and Auto Liability evidenced herein is primary and nor contributory to othere
insurance available to the Additional insured, but only to the extent required by written contract with the insQQ. A waiver
of subrogation is granted in favor Of Additional Insured sured as required y written contract but limited to the operations of the
Insured under 5 aid contract, with respect to the General Liability, Auto Liability, umbrella Liability and workers'
o
cmpensation Polic,,es.
tt--s
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESrRmE0 POLICIES BE. CANCELLED BEFORE THE
EXPIRATION DATE THEREGE, NOTICE W14L BE DELNERED IN ACCORDANCE MTH THE
POLICY PROVISIONS,
city of Clearwater AUTHORI ZED REPRESENTATIVE
Attn-, city clerk
P.o, Box 4748
clearwaLer FL 33758 USA..Jv.
@1988-2010 ACORD CORPORATION.All rights reserved.
ACORD 25(2010105) The ACORD name and logo,are registered marks of ACORD