CERTIFICATE OF LIABILITY INSURANCE (126)ACO� DATE�MMIDD/YYYY)
�� CERTIFICATE OF LIABILITY INSURANCE 06/27/2012
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 MU�U81 111SUf8I1C2 InC CONTACT William Wanless
1900 1stAve North PHONE�t �72�� $Q6-0OO6 F��,�.(727) 821-7483 _
PO Box 12350 EMAIL wvaanless@mutualinsuranceinc.com _ __ _ _
St Petersburg FL 33�� 3 INSUR�L?FFORDIN_G COVERAGE_ __ __ ___ __ � NAIC f1_ _
iN uRER A :ATSlAdmiral Ins Co _ _ _ _ _ _ _ _ _
INSURED Compass Engineering & Surveying Inc iN R R : Auto Owners Insurance Co ____ �89$$_ .,__
C Fred Deuel & Assoc i RE •SUM/Bridgefield Cas Ins
565 S Hercules Ave i R.Southern Owners �ns 10190 _
Unit 11 & 12 IN R R E• — -
Clearwater FL 33764-
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE �EEN ISSUED Tv THc I�SvRED NAM�C ABOVE FOR THE POLICY FERfOD
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. __
D � GENERAL LIABILITY 20689391
�
� Xj� y COMMERCIAL GENERAL LIABIUTY
CLAIMS-MADE CI OCCUR
I X No Deductible �
LIMIT
B �AUTOMOBILE IIABILITY
� X I� ANY AUTO ,_
� ALL OWNEC '
AUTOS I'
�Xi �
�_ _ HIREDAUTOS L
B i X I UMBRELLA LIAB
I � EXCESS UAB
'PUES PER:
_�
� LOC
SCHEDULED �
AUTOS '
NON-OWNED II
AUTOS
X.;�� OC� CUR !�
I �I DED i X( RETENTION$ �O,OOOI
C WORKERS COMPENSATION ��
� AND EMPLOYERS' 11ABILITY Y I N �!.
�, ANY PROPRIETOR/PARTNER/EXECUTIVE � I� N I A
� OFFICERlMEMBER EXCLUDED?
� (ManCalar/ ir !!!i) . �I �
�� It yes, describe under
RI F P RA
A i Architects & Engineers Professional
� Liability - Claims Made i
! $5,000 Deductible
0/13/2011 �10/13/2012
TO RENTED
1,000,000
300,000
10,000
1,000,000
1,000,000
1,000,000
170300 �10/13/2011 10/13/2012 Faa�n�Pnt�__.__—_— $
COMBINED SINGLE LIMIT 'I OOO,OOO
Ij �-$-�--- -� -�-- ��--
j BODILY INJURV (Per person) $
I ----- -----�� --- �--. _._.
��I � BODILY INJURY (Per accident) �, $_ , _ ._
PROPERTY DAMAGE T
I �Per�ccis�eotl--- li $ -----
i � I$
1901
9615870
E000000904605
0/1312011 �10113/2012 ��cH occuRRErv_cE
i I�GGREGATE ._____.
i
8/01/2011 OS/01I2012 ��I rnRVT T �� T� X
i
F E,l. EACH ACCIDENT _
II F L_f11SFFSE.-_EA EMI
� E.l. DISEASE - POLIC`
�6/15/2012 06/15/2013 Each Occurence
Aaoreaate
DESCRIPTION OF OPERATIONS / LOCATIONS 1 VENICLES �Attaeh ACORD 101, Additlonal Remarks Schadule, if mors spacs is roquirsd�
City of Clearwater
Attn: City Clerk
P O Box 4748
Clearwater
ACORD 25 (2010/05)
FL 33758-
TION
1,000,000
1 000,000
1 000,000
_._ --- . ...
�,000,coo
1,000,000
1, 000,000
RECEI�/ED
JUN 2 8 2012
OFFICIAL �RDS AI�ID
t Ec�.��em� SRV�s n�PT
A1016116
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, N0710E WILL BE DELIVERED iN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
�c �GA,r, �
�O 1988-2010 ACORD CORPORATION. All rights reserved.
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