CERTIFICATE OF LIABILITY INSURANCE (227)Client#: 2749 PLISARC3
DATE (MMIDDIYYYY)
AC,C�R.U�, CERTIFICATE OF LIABILITY INSURANCE 08/30/2012
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE QOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE pOES 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 INS R�D, 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:
SunCoast Insurance, div of USI PHONE g13 289-5200 F�, No ; 8132894561
AIC No Ext :
P.O. BOX 22F)BH E-MAIL
ADDRESS:
Tampa, FL 33622-2668
CUSTOMER ID #:
813 289-5200
OVERAGE NAIC #
INSURED
Plisko Architecture, P.A., AIA
800 Drew St
Clearwater, FL 33755
INSURER(S) AFFORDING C
�r,suReRa: Phoenix Insurance Company 25623
iNSUReR a: Travelers Casualty & Surety Co 31194
�r,suReRC: XL Specialty Insurance Company 37885
INSURER D :
INSURER E :
COVERAGES CERTIFICATc NUMBEIt: REVISIOW 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 PO�ICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
L R TYPE OF INSURANCE N R POLICY NUMBER MM/DD/VYW MMIDD/YYYY LIMITS
A GENERAL LIABILITY 6602432R749 06/18/2012 06/18/201 EACH OCCURRENCE $� ,0��,���
DAMAG R NT D OOO,OOO
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $�,
CLAIMS-MADE � OCCUR MED EXP (Any one person) $� 0�0��
PERSONAL & ADV INJURY $'I �OOO,OOO
GENERALAGGREGATE $Z�OOO,OOO
GEN'L AGGREGATE LIMIT APPLIES PER: i PROOUCTS • COMP/OP AGG $Z�OOO,OOO
POLICY PR� LOC $
A I AUTOMOBILE LIABILITY 6602432R749 $/201 COMBINED SINGLE LIMIT $
(Ea accident) � ��Q QQQ
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED AUTOS A�G 3 i 2�2 gpDILY INJURY (Per accident) $
i
SCHEDULED AUTOS +y�@/� !,� F PROPERTY DAMAGE $
X HIRED AUTOS ��°�iiri,e�il, �L;�,t�� `�" ?i A, i; +� (Per accident)
L����� ��V' S �l,��i' $
X NON-OWNED AUTOS $
UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _
i
EXCESS LIAB ' CLAIMS-MADE AGGREGATE $
� DEDUCTIBLE $
' �RETEN710N � $
B WORKERSCOMPENSATION UB%O$OYrJ�irJ 9/01/2012 09/01/201 X WCSTATU- OTH-
I AND EMPLOVERS' LIABILITY Y� N
ANY PROPRIETOR/PARTNER(EXECUTIVE I E.L. EACH ACCIDENT $') OO�OOO
OFFICER/MEMBER EXCLUDED? N�A
(Mandatory in NH) � i E.L. DISEASE - EA EMPLOYEE $� �0,0��
� If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $SOO�OOO
C �Professional DPS9702881 9/17/2012 09/11/201 $1,000,000 perclaim
Liabilit $1,000,000 annl a r.
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addltional Remarks Schadule, if more space is required)
Professional Liability coverage is written on a ciaims-made and reported basis.
TE
City of Clearwater
Attn: City Clerk
PO Box 4748
Clearwater, FL 33758-4748
LLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEIIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
pl.�,� � Ot9.-oc.� ,C7«---,
01988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 Of 1 The ACORD name and logo are registered marks of ACORD
#S404569/M404567 MRL