CERTIFICATE OF LIABILITY INSURANCE (223)Client#: 2687 MCCARAS3
��fCORD� CERTIFICATE OF LIABILITY INSURANCE Dg/21/ 012�
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY 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
REPRESENTATNE OR PRODUCER, AND THE CERTIFICATE HOLDER.
imr�ec i wn i: ir tne certiticate noiaer �s an nDDIT1oNAL INSURED, the policy(ies) must be endorsed. lf 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
certifcate holder in lieu of such endorsement(s).
PRODUCER �E.
SunCoast Insurance, div of USI ac N, �e : g� 3 289-5200 ac, N, : 813 289-4561
P.O. BOX ZZF>G$ AppRES3:
Tampa, FL 33622-2668
813 289-5200 CUSTOMER ID #:
INSURED
McCarthy & Associates, Inc.
2555 Nursery Road, Suite 101
Ciearwater, FL 33764
INSURER(S) APFORDING COVERAGE NAIC #
ir►sur�Ra: MSA Insurance Company 11066
iNSUReRS: SenEinel Insurance Company Ltd 11000
wsur�R c: Travelers Casualty 8� Surety Co 31194
E:
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,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
�N TYPE OF INSURANCE POLICY EFF POLICY EXP
POLICY NUMBER MMIDD MMIDDIYYYY LIMITS
A GENERAL LIABILITY X BpG95782 4/26/2012 04/26/201 EACH OCCURRENCE $� OOO OOO
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurcence $rJOO,OOO
CLAIMSMADE a OCCUR MED EXP (My one person) . SrJ��O�
PERSONAL 8 ADV INJURY a 1�OOO�OOO
GENERALAGGREGATE $Z�OOO�OOO
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $Z�OOO,OOO
POLICY PRa LOC $
B AUTOMOBILE LJABILITY X 21 UECNX5240 3/09/2012 03/09/201 COMBINED SINGLE LIMIT
X ANY AUTO (Ea acddent) $1 000 000 _
BODILY INJURY (Per person) $
ALLOWNEDAUTOS ���� �
BODILY INJURY (Per accident) $
SCHEDULED AUTOS
PROPERTY DAMAGE $
X HIRED AUTOS (Per accident)
X NON-0WNEDAUTOS ��� ^ ^01^ $
E L L $
UMBRELLA LIAB pCCUR
������� � �q� � � EACH OCCURRENCE $
EXCE33 LIAB CWMS-MADE '�q g ��� �j�/ u°+�+ c AGGREGATE 5
DEDUCTIBLE I.�Ls+t�LB'''ii 1 V B�. YO�I �►�7 �'L g
RETENTION a
C WORKERSCOMPENSATION U65848Y553 5/01/2012 05/01/201 X WCSTATU- OTH-
AND EMPLOYERS' LIABILITY Y/ N �
ANY PROPRIEfOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $rJOO�OOO
OFF�CER/MEMBER EXCLUDED7 ❑N N�A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE SSOO�OOO
If yes, desaibe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $rJOO�OOO
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 107, Additlonal Remarks Schedule, I( more space Ia required)
RE: Engineer of Record.
City of Clearwater is an Additional Insured as respects the Automobile Liability policy where required by a
(See Attached Descriptions)
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Arttl• City Clerk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
' ACCORDANCE WITH THE POLICY PROVISIONS.
P.O. Box 4748
Clearwater, FL 33758-4748 AUTHORIZED REPRESENTATIVE
0�9� n�. 0�--ot.� ,�----
� 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 of 2 The ACORD name and logo are ragistered marks of ACORD
#S4031601M376739 JMB
AMS 25.3 (2009/09) 2 of 2
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