CERTIFICATE OF LIABILITY INSURANCE (130). __
aCO � CERTIFICATE OF LIABILITY INSURANCE °ATE,M""°°'""'",
�,,,i� oaizoizo�2
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 Mutual Insurance Inc coNracr �Iliam Wanless
1900 1st Ave North PHONE �72]� $Q6-0006 FAX .(727) 821-7483
PO Box 12350 E-A^�41L wwanless@mutualinsuranceinc.com
St Petersburg FL 33713 INSIIRFR/Sl AFFOR�ING COVERAGE NAIC #
INSURED Compass Engineering & Surveying Inc
C Fred Deuel & Assoc
565 S Hercules Ave
Unit 11 & 12
Clearwater FL 33764-
,TS/Admiral Ins Co
Auto Owners Insurance Co
�UM/Bridgefield Cas ins
�outhern Owners Ins
18988
0190
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,
EXCIUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR 7ypE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
� GENERAL LIABILITY X X 20689391 ��� � 10/13/2012 EACH OCCURRENCE $ �,���,���
DAMAGE TO RENTED 300,000
COMMERCIAL GENERAL LIABILITY
X R $
CLAIMS-MADE � OCCUR MEDEXP An one erson $ ��,000
1^rt�^ PERSONAL & ADV INJURY $ �,OOO,OOO
AUG2 �� � GENERALAGGREGATE $ �,OOO,OOO
GEN'LAGGREGATELIMITAPPLIESPER: C A� �Awy' PRODUCTS-COMP/OPAGG $ �,OOO,OOO
POLICY PRO- X LOC ��"�ICIPti R�� " � $
B AUTOMOBILE LIABILITY X X 4699170300 L�'� 10/13/2012 COMBINED SINGLE LIMIT �,��D,OQQ
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accidenl) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
X HIRED AUTOS X AUTOS
$
B UMBRELLA LIAB 4700541901 10/13/2011 10/13/2012 EACH OCCURRENCE $ 1,000,000
OCCUR
X EXCESSLIAB � AGGREGATE g �,OOO,OOO
CLAIMS-MADE
$
C WORKERSCOMPENSATION 019615870 �$/01/20�2 08/01/2013 X nRViATU- OTH-
AND EMPLOYERS' LiABILITY y � N 'I,OOO,OOO
ANY PROPRIETOR/PARTNERlEXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBEREXCLUDED? � N�A 'I,OOO,OOO
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under E.L. DISEASE - POLICY LIMIT $ �,���'���
DES RIPTI N FO RATI N below
A Architects & Engineers Professional E000000904605 06/15/2012 06/15/2013 Each Occurrence 1,000,000
Liability - Claims Made Aggregate 1,000,000
$5,000 Deductible
DESCRIP710N OF OPERATIONS / LOCATIONS / VEHICLES (AHach ACORD 101, Additlonal Remarks Schedule, It more space Is requlred)
30 days notice of cancellation except for 10 day days notice for non-payment of premium.
I+CI�TICIf�I�TG LJA1 �eo CANCELLATION _ AI 016404
City of Clearwater
Attention: City Clerk
P 0 Box 4748
Clearwater
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED iN
ACCORDANCE WITH THE POLICY PROVISIONS.
FL 33758-4748 I AUTHORIZED REPRESENTATIVE
�O 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD