CERTIFICATE OF LIABILITY INSURANCE (209)Client#: 6108 GRIMCRA3
ACORDTM CERTIFICATE OF LIABILITY INSURANCE D06/01/2012 )
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 ac No EX� : g13 289-5200 �ac, No�: 8132894561
P.O. BOX ZZGGS E-MAIL
Tampa, FL 33622-2668 ADDRESS:
813 289-5200 CUSTOMER ID #:
INSURED
Grimail Crawford, Inc.
4600 W. Cypress St., Suite 550
Tampa, FL 33607
COVERAGES
CERTIFICATE NUMBER:
INSURER(S) AFFORDING COVERAGE NAIC A
iNSUReRa: Phoenix Insurance Company 25623
�NSUReR s: XL Specialty Insurance Company 37885
INSURER D :
INSURER E :
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 fJF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLA�MS.
INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS
POLICY NUMBER MM/DD MM/OD
A GENERAL LIABILITY s$OrJZHOLS4O 10/14/2011 10/14/201 EACH OCCURRENCE $2 000 000
X COMMERCIAL GENERAL LIABILIN PREMISES Ea oocurrence $� �OOO�OOO
CLAIMS-MADE � OCCUR MED EXP (My one person) $� �,0��
PERSONAL & ADV INJURY $Z,OOO,OOO
GENERALAGGREGATE $4�000�000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $�i�OOO�OOO
POLICY PR� LOC $
A AUTOMOBILE LIABILITY BA220M63RE /30/2011 11/30/207 COMBINED SINGLE LIMIT
(Ea accident) $� �QQ 00�
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED AUTOS
SCHEDULED AUTOS
JUN 0 6 201 gODILY INJURY (Per accident) $
X HIRED AUTOS ( ROPERTY DAMAGE $
Per accident
X NON-OWNED AUTOS OfFICIAI R�CfJRD APID $
DEPT $
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY Y/ N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? � N�A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
B Professional DPR9701929 05/29/2012 05/29/201 $2,000,000 per claim
Liabilit $2,000,000 annl a r.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (AtWch ACORD 701, Additional Remarks Schedule, If more space is required)
Professional Liability coverage is written on a claims-made and reported basis.
RE: City of Clearwater Engineering of Record
City of Clearwater
Engineering Dept. Ste. 200
Attn: Susan Chase
PO Box 4748
Clearwater, 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
OL�� �n. 0�.-C1L.o .�.•-----.
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