CERTIFICATE OF LIABILITY INSURANCE (228)1 Client#:6108 GRL_ _,2A3
�ACORD�M CERTIFICATE OF LIABILITY INSURANCE DATE�MMIDDIYYYV)
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANO 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: _ _
USIISuncoast-Tam a PHOaE - — - —
P �ac No, Ezq 813 289-5200 j,�� No�. 813 289-4561
P.O. BOX ZZGSS E-MAIL __ _ _ _ _ -- - _
ADDRESS:
Tampa, FL 33622-2668
CUSTOMER ID #: __ .
813 289-5200 ___--_.______ ______ _
INSURER(S) AFFORDING COVERAGE NAIC !F
INSURED INSURER A� PhOCf11X IIlSUP8t1C8 COISIj)811j/ 25623
Grimail Crawford, Inc.
4600 W. Cypress St., Suite 550
Tampa, FL 33607
._._---��---- --_.. ._ .___..
�r,suReR e: XL Specialty Insurance Company
INSURER C :
INSURER D :
INSURER E :
INSURER F :
37885
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 PO�ICY 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.
INSR 7ypE OF INSURANCE L 6UBR POLICY EFF POLICV EXP
L NSR WVD POIICY NUMBER , MMlDD/YYYY MMIDDNYYY LIMITS
A GENERAL LIABILITY X i 6805280L540 ��10I14/2011 10/14/201 EACH OCCURRENCE $2��������
' GE N ED
Xi COMMERCIAL GENERAL LIABILITV I I PREMISES Ea occurrence S� �OOO�OOO_ __
. �.. ------�----- - � - ---- —
� CLAIMS-MADE �� OCCUR �, �'�i MED E7(P (Any one person) $� ��0�0
-------- ----._____. -- -----
� � PERSONAL & ADV INJURY _ _ $Z�OOO OOO
-- I . .--- ----. _ _. __------�--- �' - ---_____--- - - -'---- - -- _ _..
I
�I � '�. GENERALAGGREGATE $4�000�000
GE _._- -_.__ ____ ..__._. ' -
N'L AGGREGATE LIMIT APPLIES PER i j PRODUCTS - COMP/OP AGG $4,000 OOO
. __ . _._- --- ._ - -�--- ---
, -- �
�� POLICY .... PRO- - 1 LOC ; �'�.�'.
A AUTOMOBILE LIABIIITY BAZZOMGSGG 11I30/201 COMBINED SINGLE LIMIT $
II
� (Ea acadent) �i000�000 . _ _ _
X ANY AUTO �I BODILY INJURV (Per person) $
i
ALl OWNED AUTOS �'� '
� '! (� ' BODILY INJURY (Per accident) $
! SCHEDULEDAUTOS � �UV a� O �0�� � � ��
�, PROPERTY DAMAGE $
X� HIRED AUTOS ��.. (Per accident)
X'� NON-OWNED AUTOS �'!
O�FICiAl. RE��i?� � - ----- - $ -
$
I UMBRELLA LIAB OCCUR � ! EACH OCCURRENCE S
� EXCESS LIAB CLAIMS-MADE ��.. �i AGGREGATE $
DEDUCTIBLE ��, ��� �'
RETENTION $ I' . �. $
WORKERS COMPENSATION '�� i 'I WC YTATU- OTH-
AND EMPLOYERS' UABILITY y� N ��' ',,
ANY PROPRIETOR/PARTNER/EXECUTIVE❑ ' '�, E.L EACH ACCIDENT $
OFFICERlMEMBER EXCLUDED? N�A � '.,
(Mandatory in NH) ��, � EL DISEASE - EA EMPLOYEE $
If yes, describe under I �
DESCRIPTION OF OPERATIONS below ' E.L. DISEASE - POLICY LIMIT S
B Professional DPR9701929 ';05/2912012 05/291201 a2,000,000 per claim
Liabilit ' $2,000,000 annl a r.
DESCRIPTION OF OPERATIONS I LOCATIONS I VEH�CLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required�
RE: Engineer of Record RFQ16-12. The City of Clearwater is an Additional Insured as respects the Commercial
General Liability policy where required by a written contract prior to a loss per policy terms and
conditions. Professional Liability coverage is written on a claims-made and reported basis.
City of Clearwater
Attn: City Clerk
PO Box 4748
Clearwater, FL 33758-4748
SHOUID ANY OF THE ABOVE DESCRIBED POIICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICV PROVISIONS.
AUTHORIZED REPRESENTATIVE
IpL�F �+. Ots--ot., ,�L•�--
01988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) � p{ � The ACORD name and logo are registered marks of ACORD
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